Top News

A JAMA editorial calls for CMS to release Medicare Advantage encounter data to allow taxpayers to see how their money is being spent on its growing number of beneficiaries. The article concludes that if the data is good enough to pay providers from, it’s good enough for the public to see.

Reader Comments

From Jagged Pill: “Re: Orlando Health’s CIO position. It’s interesting to compare the stated job requirements with the credentials of the chosen candidate.” The job description doesn’t contain the requirement that the new VP/CIO have experience in an organization of similar size ($3.4 billion), but some might be surprised that new CIO Novlet Mattis got the job with just four years of CIO experience, all of that accrued in one-hospital, $954 million Rex Healthcare (NC). She came from Ascension Information Services, so maybe there’s a consulting connection there. The job description also says that Orlando Health will be choosing a new EHR and replacing its best-of-breed systems, which will be a huge loss for Allscripts (Orlando Health paid them $5.1 million in FY2016, according to tax filings) and a big win for Cerner or Epic. A local announcement says the IT department’s annual budget is $145 million. According to those same tax filings, retired CIO Rick Schooler was making $785K per year. Another interesting tidbit is that Orlando Health’s VP/CIO position reports to the CFO, which is almost unheard of except in small hospitals where the primary objective is controlling cost.

From Jack Anape: “Re: Mitre’s report on Cerner interoperability. Will the VA make it available to the public?” I haven’t heard what’s in the report, but I would bet the VA won’t release it publicly, especially since it looks like there’s about an 80 percent chance that VA Secretary David Shulkin will be shown the door after ending up on the wrong end of White House infighting. What the report says is anyone’s guess, but given that its emphasis was on how Cerner would interoperate seamlessly with whatever EHRs are being used by community-based providers that might treat a veteran, it doesn’t seem likely that the report will provide a ringing endorsement. There’s also the chance the White House-pushed, no-bid contract Cerner signing could be put on hold or the EHR decision process restarted if Shulkin isn’t there to promise Congress that this time, the VA really, really, really won’t blow through taxpayer IT billions without much to show for it.

HIStalk Announcements and Requests

I’m enjoying the responses to “What I Wish I’d Known Before … Taking a Travel-Heavy Job.” Add yours and you’ll see it in this weekend’s write-up.

Welcome to new HIStalk Platinum Sponsor WebPT, the most-trusted, industry-leading rehab therapy software platform. The Phoenix, AZ-based company’s robust, Web-based solution – created by a therapist for therapists — offers EMR, scheduling, documentation, billing, outcomes tracking, business reporting, patient engagement tools, and system integration in enhancing patient care and driving business growth regardless of staff size, facility type, or number of specialties. The company has a 99 percent customer retention rate, 99.99 percent uptime, 10,000 clinic customers, and 79,000 member users. The company announced last week its acquisition of BMS Practice Solutions, the largest rehab therapy RCM company. WebPT offers video testimonials and case studies that explain why more therapy professionals rely on WebPT than any other software. Industry long-timer Nancy Ham is CEO and board member. Thanks to WebPT for supporting HIStalk.

Here’s a physical therapy practice’s WebPT testimonial that I found on YouTube.

Welcome to new HIStalk Platinum Sponsor Philips Wellcentive. The Alpharetta, GA-based company has since 2005 driven quality improvement, revenue growth, and business transformation for healthcare organizations that are transitioning to value-based care. The company’s population health management solution boosts clinical, financial, and human outcomes and has been recognized as a PHM leader by KLAS, IDC, and Chilmark. Philips Wellcentive helps its customers provide care management for nearly 50 million people, using intelligence gained from 2.5 billion data points each month to earn $700 million each year in value-based revenue through improved outcomes. I interviewed PHM Business Leader Niki Buchanan a couple of weeks ago. Thanks to Philips Wellcentive for supporting HIStalk.

Government and Politics

A perceptive New York Times article says that a widening gap between Americans who pay full price for their ACA marketplace health insurance and those who get free or heavily subsidized coverage causes some of the resentment against social programs that middle-class citizens pay for. It concludes that the only universally liked social programs are Social Security and Medicare because everybody benefits from them.

Researchers create a live tracking website to call out organizations and individuals that aren’t complying with a new law that requires that all completed or abandoned FDA-registered clinical trials to publish their results, good or bad. Interestingly, the FDA itself has no plans to do tracking of its own. Clicking an organization’s name shows every clinical trial that it has underway, which then links to the ClinicalTrials.gov site for full study details.

HHS issues a proposed rule that will allow insurers to sell short-term health insurance plans that don’t meet ACA requirements. CMS says lower premiums will allow people to buy insurance who otherwise can’t afford it, although it doesn’t mention that bare-bones plans historically have barely resembled real health insurance with a long list of excluded services and no coverage of pre-existing conditions. Not to mention that they will likely destroy what’s left of the marketplace risk pool. I looked at some of the plans offered and they have deductibles as high as $12,500, 40 percent co-insurance up to a maximum of $10,000 annual out of pocket, no coverage for conditions that have been treated in the preceding 24 months, and a lifetime maximum of $600,000 (your cancer and stroke crystal ball had better be accurate). HHS Secretary Alex Azar said in a tweet that the change will offer people “quality, affordable healthcare that works for them,” although he didn’t mention whether he or members of Congress who are covered by generous, taxpayer-paid plans with ACA-mandated coverage are planning to trade theirs in.

Privacy and Security

California Attorney General Xavier Becerra says he won’t sign off on mandatory physician use of its CURES prescription drug monitoring program until its security has been certified.

Other

A KLAS report on clinical mobility finds that few hospitals are keeping late-model iPhones for employee use like they did before the iPhone 6, with some of them instead moving to Zebra phones because of the iPhone’s shortcomings (lack of ruggedization, poor WiFi connectivity, and lack of swappable batteries). The iPhone is still the first choice for executives and doctors who get a hospital-provided phone to keep. BYOD strategies include paying employees a stipend for using their own phones for work, providing secure texting apps, securing the device remotely via mobile device management, offering remote system log-in as a value-added option, allowing employees to disconnect while not on call, and blacklisting apps if necessary.

Google researchers apply deep learning to images of the eye (specifically the retinal fundus) to accurately determine cardiac risk factors, such as a patient’s age, gender, smoking status, blood pressure, and likelihood of having a heart attack. They hope to expand their work with a larger dataset in which more cardiovascular events occurred and to fine tune their risk prediction by looking at lifestyle changes or medications.

Eric Topol notes that healthcare has morphed from a small industry to the country’s largest without improving outcomes.

A tiny physician survey finds that three-quarters use mobile health in their practice, but mostly only for internal messaging or for quick EHR lookups on their phones. Almost no practices offer telemedicine visits, although that doesn’t necessarily mean their patients aren’t using it – maybe they’re just getting them elsewhere. Few practices accept information from patient wearables, most commonly because the data doesn’t flow into their EHR , although I would bet the real reason is they aren’t being paid to review the information and are afraid of being sued if they miss something.

A medical resident’ s opinion piece ponders whether “the academic arms race” gunner competition among medical school applicants creates better doctors or perhaps instead burns them out. It made me think – are intelligence, drive, and competitiveness the best predictors of being a caring doctor?

Experts warn that the US military’s planned surge will struggle since three-fourths of Americans aged 17-24 are ineligible to serve because of obesity, other health conditions, criminal backgrounds, or lack of education. From the non-military viewpoint, that means employers will either have to hire them warts and all or they’ll be unemployed and thus supported by taxpayers.

In Australia, the Royal Australasian College of Physicians goes back to paper for its medical trainee exam after its first attempt at using a computer-based system locks users out five hours into their test. Test-takers who were planning to leave immediately afterward for vacation or to curl fetally in the corner from panic attacks over their future now have to prepare for the paper re-test that will be administered on March 2.

Sponsor Updates

Hands On Technology will integrate Ability Network’s RCM application into its rehab EMR/PM.

PatientKeeper and its owner HCA are awarded a patent for the way its software displays the most relevant patient information based on the user’s specialty and preference.

Top News

Committee members fretted about the appearance of privatizing of the VA in giving veterans an option to turn to community providers for timely care, the VA’s cost of which has risen dramatically with higher usage.

Rep. Phil Roe, MD (R-TN) said the value of the Cerner contract alone in the VA’s EHR project will be $10 billion, not including infrastructure and VistA maintenance costs.

Rep. Roe questioned whether it will ever be possible to turn VistA off. He thinks it will need to run for many years for looking up information that can’t be converted to Cerner.

Rep. Roe said, “It is unthinkable that the VA could potentially spend billions of dollars on a project that doesn’t substantially increase the department’s ability to share information with DoD or community providers.”

VA Secretary David Shulkin said the VA doesn’t have an EHR, it has VistA, which he says is instead “130 electronic records,” referring to the “different parts of VistA.”

Sec. Shulkin said he paused the project to make sure that the VA can exchange information with community providers, as 36 percent of veterans are getting care in the community. He said the American healthcare system hasn’t yet figured out interoperability, but the VA can lead the way.

Rep. Jim Banks (R-IN) questioned the rollout of a scheduling system given that the pending Cerner project has “run into trouble.” Sec. Shulkin said the VA’s Epic scheduling project (MASS) pilot will go live in Columbus, OH in March and the VA is looking forward to seeing how it works. Commercial scheduling products are being tested at three other sites.

Reader Comments

From Ticklish: “Re: opioid crisis. This article says it’s caused by a lack of interoperability. Think so?” Of course not. Short-sighted healthcare people forget that prescribed, FDA-approved opioid drugs make up just part of the available smorgasbord of narcotics, and in fact, their higher cost and reduced availability is pushing users to cheaper, more easily obtained forms that doctors and hospitals don’t control. I’m not convinced that anything can stop the use of drugs by determined people, but if there is a magic bullet, I’m certain it isn’t prescription databases, cracking down on supply, or mass incarceration. And while everybody was focusing on Oxycontin, crystal meth usage has returned with a vengeance lately with purer, cheaper product available everywhere, so now there’s that massive scourge to deal with again. Our real problem is that a huge chunk of our society (one in seven, according to the Surgeon General) finds living in an un-medicated state intolerable, apparently not really caring whether their minds are altered by depressants (including alcohol), stimulants, or both. That massive demand and the associated profit will assure a steady supply that can’t be stopped, even by admirably trying to contain opiate over-prescribing.

HIStalk Announcements and Requests

Digital health apps already have challenges with proving their worth, but here’s another problem: half of poll respondents – presumably most of them being health IT experts — wouldn’t be happy at having an app prescribed instead of a medication. Maybe the unstated problem is that the mental picture of a “digital health app” is a patient portal, activity tracker, or record-keeping system instead of an FDA-approved treatment that delivers proven outcomes.

New poll to your right or here, as suggested by a reader: What impact would a job candidate’s CPHIMS credential have on your hiring decision? Long-time readers may remember that I asked this same poll question way back in 2009 and 2010.

Listening: new from Superchunk, angry protest poetry cloaked in masterfully crafted indie punk-pop. The Chapel Hill, NC band has never lost its relevance or fierce independence, and to my ears, has never sounded better. I saw their frenetic but somehow simultaneously laid back show live awhile back and was most struck by a fan’s shouted request for some non-Superchunk song, with the laughing reply of guitarist Jim Wilbur being, “Mac [McCaughan] won’t sing any lyrics he didn’t write, so that’s not going to happen.” That’s admirable.

Webinars

Acquisitions, Funding, Business, and Stock

From the Allscripts earnings call following mostly good results that were marred by much lighter bookings than analysts expected, sending shares down 7 percent Friday:

President Rick Poulton touted the company’s acquisition of McKesson’s EIS business and Practice Fusion, saying that they give the company hundreds of new client relationships; fill several EHR portfolio gaps; create a large, actionable patient data set that life sciences and payer companies will pay for as they did under Practice Fusion; and add $300 million in annual recurring revenue, all for a net investment of $50 million.

The sales cycle is lengthening and customers are looking harder at return on investment.

End-of-life of the former McKesson Horizon Clinicals and Series 2000 product lines is March 31.

The company is pitching its DbMotion to the VA as it transitions over several years to Cerner or whatever vendor it chooses.

Allscripts declined to say how much Hyland Software is paying for the former McKesson OneContent content management business, but the Allscripts SEC filing seems to indicate $260 million plus assumption of certain liabilities minus other financial adjustments.

Research network TriNetX develops an algorithm that can deduce the line of chemotherapy treatment a patient is undergoing, helping biopharmaceutical researchers develop new therapies.

Privacy and Security

A security researcher reports a SQL injection vulnerability in Epic’s MyChart, also noting that Epic was “quick to respond to contact and patch the vulnerability.” That’s commendable – software vendors rarely behave nicely (and often threateningly) toward strangers who are nice enough to warn them of security flaws in their products. I don’t know how Epic notifies customers and distributes the patch, but I assume it will be quick now that any interested hacker could theoretically exploit it. For non-techies, SQL injection is an old hacker’s method in which they paste an SQL statement into a web page input field – such as name or city – that the web page then executes, giving the hacker access to the underlying database (read, update, delete) without having to pass through the site’s authentication.

Other

The CEO of Medical Center Health (TX) tells the board that its Cerner implementation is one of the organization’s most pressing issues, explaining, “This was an attempt to find an ideal system. That is not a possibility. There is no ideal electronic medical system.” He says he’s worked at hospitals that use Meditech and Epic and those products have the same problems. He says Cerner blamed hospital clinicians and administrators – “pretty much everyone except themselves” – for not implementing the system correctly, but says the hospital and vendor are now working together and Cerner is providing consultants at no charge. The hospital expects the implementation to come in at $47 million, $7 million under budget.

The financially struggling, 47-bed Holy Cross Hospital (NM) says its problems are due to a problematic software rollout, its conversion to a critical access fee structure, Medicaid payment delays, and a lawsuit judgment that raised its malpractice insurance by $600,000. The hospital didn’t name the system, but they started conversion from Meditech Magic to CPSI Evident last fall. The CEO said in his presentation to county commissioners last week that he should have delayed the October 1 go-live, but realized that many of the 100 on-site vendor support staff would be unavailable for a later date. He also says he regrets conducting the critical access switch and EMR conversion nearly simultaneously, but the hospital’s underlying financial problems were in place long before either.

A Miami pediatric surgeon is charged with unlawfully accessing a computer when his former girlfriend finds out that, while they were dating, he logged in thousands of times to the streaming video feed from her in-home security cameras using hospital computers. He says she gave him the password, he was just checking into her well-being, the two cameras were not the bedroom, and she didn’t complain until they broke up and he declined to pay her the $400,000 she demanded.

I like seeing a rare non-stuffy, HIMSS-related vendor press release. Cybersecurity services provider Lunarline says it is “planning for a wild HIMSS 2018,” explaining that, “Our sales team somehow convinced the conference organizers to let us serve beer at our booth. Because, you know, there is never enough alcohol in Vegas.” The company’s website is mostly dry and unremarkable, but a few glimmers of wit shine through.

I knew HIMSS was a big conference, but I didn’t realize that the impact would be that it is just hard to move around and accomplish a lot. You never really get to see the whole exhibit floor or do a lot of things because it just take so long to get there. Food lines are long, there’s no place to sit. It’s a complete workout. The startup pavilion has some of the more interesting companies and the big vendor booths are very impersonal. Then, when it is all over, you wonder what you really accomplished or learned and if it was worth all the trouble.

Wear really, truly comfortable shoes.

That my exhibitor badge gets me into educational sessions as well. Someone more experienced at these events helped guide me in finding helpful sessions for my area of expertise.

Very long hours on your feet. I have a pair of super supportive shoes I call “my HIMSS shoes” and I am never without them.

HIMSS is all about making and strengthening business relationships. But on the floor, you literally have about 30 seconds to get someone’s attention and earn the right to have a meaningful conversation.

As an exhibitor, it can devolve into a party atmosphere, quickly. Pace yourself.

Wear comfortable, not necessarily stylish, shoes.

Wear comfortable shoes!

The exhibit hall is like the Caribbean, full of ports (booths) and buyers are like cruise ship passengers. The enthusiasm doesn’t always stick once they get home and visitors will confuse ports/vendors. Give them something memorable (in good way) and be prepared to present again after HIMSS if you want them to truly remember anything you showed them.

Be careful about scheduling meetings first thing in the morning after the first day. Last day first or last are the worst times for any real business to happen.

Stop at two drinks. Period. It’s possible, even likely, that key people in the industry are around you at all times, even 1 a.m. in the hotel bar. Remember that this is your career and you’re making an impression even after exhibit hours are done.

Make reservations for every anticipated meal, even if for two people, as everything will be packed. And, if invited to a meal by a vendor, verify that that vendor has a reservation inclusive of all invited attendees. I attended a breakfast at a previous HIMSS with a vendor where the rep from the vendor did not make reservations for an intolerably crowded joint and eight executives huddled around a bar-height bistro table for two in the hallway of the casino discussing the strategic direction of our partnership.

How your message gets lost in the noise and the value proposition is questionable, unless you are one of the larger vendors.

The amount of time you will be on your feet. I have HIMSS shoes, comfortable, dressy shoes half a size too big with the most cushioning insoles I could find and hiking socks.

Establish scheduled meetings before or during HIMSS if you are looking to sell (vs. touch current customers, develop business development relationships, or perpetuate your brand). It is not worth pulling anyone off the floor to learn about your product anymore since, unlike in the early days, most of the folks walking the floor are fellow vendors.

HIMSS is in a conference that companies in the healthcare information technology industry must attend even, if the value for doing so is minimal. Pulling out is a public red flag that there is a problem or at least a big change in the company. So we go and represent with minimal expectation of value, but it can be fun for the team selected to the representing.

Top News

Drug maker Roche will acquire oncology EHR and personalized medicine vendor Flatiron Health for a $1.9 billion in cash, valuing the company at $2.1 billion including Roche’s previous investment in it.

Flatiron had raised $313 million in three funding rounds from 2013 to 2016. The company was valued at $1.2 billion just two years ago.

Nat Turner and Zach Weinberg started the company in 2012 after selling their previous advertising technology company to Google for $70 million. Google Ventures, now Alphabet, invested $130 million in Flatiron Health in May 2014. The founders graduated from The Wharton School’s undergraduate program in 2008, which would make them around 32 years old.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Loyale Healthcare. The Lafayette, CA-based company– founded in 1990 as CashNet – helps make a patient’s financial experience as positive as their clinical experience. That’s especially important as patients become responsible for a bigger portion of their healthcare costs. The company’s predictive analytics and behavioral indicators create personalized patient financial plans and workflows that allow providers to conduct honest conversations about treatment costs and payment responsibility. Patients appreciate getting the transparency and support they need to feel in control, while provides are taking the cue of successful retailers who recognize that their most valuable asset is their customer relationships. They can increase revenue, decrease staff time, and minimize bad debt while providing personalization that optimizes affordability and collections. Loyale’s patient relationship portal provides balance notification, combined statements, 24/7 self-service, online payments, and secure digital communication. Its platform applies KPIs, best practices, red flags, and analysis of patient sentiment and behavior while integrating with all leading systems. Thanks to Loyale Healthcare for supporting HIStalk.

Webinars

Acquisitions, Funding, Business, and Stock

Allscripts reports Q4 results: revenue up 22 percent, EPS $0.18 vs. $0.14, meeting earnings expectations and beating on earnings. Bookings fell far short of expectations, however, sending shares down in early after-hours trading Thursday. The company announced that it will sell the OneContent document management software business it acquired as part of McKesson EIS to Hyland Software for undisclosed terms.

Nokia announces that it is conducting a strategic review of its digital health business just two years after it created it by acquiring connected health hardware vendor Withings for $212 million. Nokia had already written down $164 million worth of goodwill related to the business in October 2017.

The Chartis Group acquires Atlanta-based consulting firm Oncology Solutions for an undisclosed sum.

Ellkay relocates to larger office space in Elmwood Park, NJ that will accommodate up to 500 employees.

Aetna defends its medical review practices following the publication of quotes from the testimony of a former medical director who said he never reviewed patient records in making coverage decision. Aetna says:

The story was pushed by a former patient who is suing Aetna and was “conveniently” published just days before the trial was scheduled to begin.

The medical director said in a sworn statement that he always reviewed the relevant portions of medical records, nurse summaries, notes, and the company’s Clinical Policy Bulletins.

Aetna has paid for all of the $20,000-per-dose treatments of the patient who is suing them. That person remains an Aetna member. The only treatment interruption he experienced happened because he refused to provide blood work ordered by his doctor.

Government and Politics

A federal judge rules that the DOJ can move forward with a lawsuit against UnitedHealth that claims the payer bilked Medicare out of $1.4 billion by submitting invalid diagnostic data for Medicare Advantage plan members.

Innovation and Research

A retrospective study shows that patients who used Glytec’s Glucommander Outpatient insulin therapy management tool and self-tested blood glucose levels twice a day saw better outcomes, including a 3 percent reduction in A1c levels, than those who did not.

Other

An Allscripts client newsletter says the company’s counsel has concluded that its practice customers do not need to notify patients or OCR following its January ransomware attack.

EClinicalWorks posts a nicely done video that describes the work of Petaluma Health Center (CA) during the Northern California wildfires of October 2017.

Contacts

Top News

The White House’s budget request would give the VA $1.2 billion in FY2019 funding to begin its Cerner implementation, broken out as $675 million initial payment for the Cerner contract, $120 million for program management, and $412 million for infrastructure support (which includes VistA modernization).

Cerner has apparently passed the third-party review of its interoperability capabilities that was holding up contract signing. The VA says it expects to finish the deal within three weeks.

Reader Comments

From Informatics MD: “Re: AI in radiology. We pre-process CT scans using deep machine learning, imaging analytics, and clustering optimization techniques to look for evidence of strokes. If suspected, it re-prioritizes the PACS worklist so that the radiologist reads the suspected film sooner. This is particularly useful with ambulatory diagnostic imaging since the time from study to read can be longer than in the acute setting.” That’s pretty smart to use AI to move images of suspected stroke patients to the highest radiologist priority.

From Alababa: “Re: Craig Richardville SVP/CIAO of Carolinas HealthCare. Has left the organization.” Unverified, but his bio has been removed from the executive page. UPDATE: a spokesperson from the newly renamed Atrium Health confirms to the Charlotte newspaper that Craig no longer works there.

From Moody: “Re: HIMSS. I’m going for the first time. As a hospital employee, how should I plan?” Just off the top of my head:

Arrive at least a day early to avoid the starter’s pistol rush of all the other badge-wearing attendees on the first day.

If you don’t arrive early, do anything you can to avoid the airport cab line and the inevitable two-hour wait.

It’s Las Vegas, so if you haven’t been there, be prepared to be shocked by the sleaze but intrigued by the tricks and big data analysis those billion-dollar hotel casinos use to keep people losing money while thinking they’re having a great time.

Prepare to be overwhelmed with the amount of advertising real estate HIMSS sells – on escalators, floors, buses, and just about any item someone hands you. All of that contributes to ridiculous healthcare costs, but in the vendors’ defense, it apparently works.

Dress comfortably, not to impress. You won’t be impressive by Day 2 when you are hunched over and limping from walking 10 miles in stylish but uncomfortable shoes.

Housing choice is up to you, but I always VRBO a house or condo instead of shoehorning in with all the other badge-wearers in the conference hotels. It’s a cheap Lyft ride to the convention center. It probably costs a bit more unless you share your space, but decompressing away from the HIMSS herd is worth it, plus you aren’t stuck eating overpriced, unhealthy food and being forced to mingle everywhere you turn. Otherwise, especially if you lean toward introversion, you will find yourself sitting on the floor of unused corners of the convention center just to get some quiet.

Expect to see only 5 percent of what’s going on. Study the program guide ahead of time to identify the potentially most valuable 5 percent. Even then, expect to be disappointed.

Skip the keynote sessions. You can read about them even before they happen since HIMSS puts a recap from the speaker’s draft in the daily conference rag.

Ask fellow attendees what they found valuable to see in the exhibit hall or have them message you if there’s a really good session underway that you can crash.

The exhibit hall provides educational polarity. You can learn a lot there, but you can also waste a lot of time that could have been better spent elsewhere instead of just wandering around aimlessly.

Walk out on any session that under-delivers and find another one. Or, skip them all and just read the slides or listening to the recordings afterward (they’re included in your registration)

Don’t attend any educational session that features a vendor employee as a presenter.

Talk to peers. The biggest HIMSS takeaway is often the relationships built there.

Don’t treat the conference as a vacation blowout. Your employer is paying for your education, not to sleep in after over-imbibing.

Don’t schedule time with a vendor. It is incredibly inefficient to be clock-watching the time you need to start walking miles to visit a vendor’s booth at a pre-arranged time. You’re the prospect – they will make time for you when you show up.

Flip your badge over backwards if you want to walk around in the exhibit hall unmolested.

Take your badge off as soon as you leave the convention center to avoid looking like every other HIMSS conventioneer zombie wandering around on the Strip, an easy target for scammery and ridicule by decidedly low-brow, non-HIMSS visitors.

Don’t leave the conference thinking that you or your employer are under-accomplished compared to what you heard and saw, most of which was BS. It’s like loud-mouth Las Vegas gamblers – they will crow endlessly about their big win while failing to disclose the 100 losses that left them well into the red.

Write up what you learned for your boss who had to approve the cost of your trip or offer to share your new knowledge with your team who didn’t get to go.

Marvel at the fact that, like monstrous hospital buildings, the excesses of the HIMSS conference serves as a reminder that US healthcare isn’t something we selflessly do for each other as empathetic humans but is rather an enormous, impersonal business that makes a bunch of people very wealthy and a far greater number of people very poor.

HIStalk Announcements and Requests

I finally got around to looking into encrypting the site, which is becoming the standard across the Web. That’s done – SSL encryption is in place, so your browser will indicate “https” and will show the closed lock in the address bar. As a reader notes, you can now enter a comment without wondering if your employer might intercept it (so hey, might as well).

Webinars

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsor: Strata Decision Technology. Presenter: Patrick Nolan, VP of finance, Aurora Health Care. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

Acquisitions, Funding, Business, and Stock

Fitbit acquires app-powered health coaching provider Twine Health, hoping to tie Fitbit’s wearables into the management of chronic conditions. Or perhaps the synergy involves two companies that eschew the use of properly capitalized words in their logos. Twine Health had raised $10 million in funding.

A Wall Street Journal report says Amazon will expand its Amazon Business program to sell medical supplies to hospitals and clinics, sending shares of McKesson and other wholesalers down sharply. Amazon could make a fortune shorting stocks in sectors that it then rumors it will enter.

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StayWell, a population health management and patient education technology vendor owned by drug maker Merck, acquires Provata Health, which offers lifestyle and chronic disease management apps. Provata Health raised a single funding round of $1.4 million from NIH in August 2015 and doesn’t seem to have done much since mid-2016 except try to create a virtual reality meditation product. StayWell acquired health app vendor MedHelp in October 2017.

Cerner files its employment agreement with new Chairman and CEO Brent Shafer with the SEC. He gets $11 million in stock options, a $4 million stock option grant, a one-time grant of $3.7 million in restricted stock units, use of the company’s jet, relocation expenses, $800K in annual salary, and a $1.2 million annual bonus target. His golden parachute calls for two years’ worth of salary, average bonuses, and health insurance coverage.

California launches an investigation into Aetna following the testimony of a former company medical director that he never looked at patient records when deciding to approve or deny care. He added that he had to make decisions about medical conditions that he knew little about. Aetna says its clinical review process is sound and the medical director’s job is to follow the company’s Clinical Policy Bulletins in reviewing the medical records that it must obtain manually from patients and doctors. The former medical director says nurses reviewed the patients’ records and gave him recommendations that he managed online without ever calling the nurse. He is amply credentialed, however (now running a one-person family medicine practice) so I imagine he was doing exactly what Aetna expected or ordered.

Announcements and Implementations

Providence Health & Services will offer its patients and health plan members in Oregon online exams for non-emergent conditions, with patients who complete an online questionnaire receiving an emailed treatment plan within one hour. Providers respond seven days per week between 8 a.m. and 7 p.m., with the encounter covered in full for health plan members or $20 otherwise. The technology is provided by Bright.md.

Providence Express Care created a great graphic explaining its care options, including the new SmartExam.

A Black Book report looks at EHRs across 23 countries in a 7,500-respondent survey, finding that:

Most international users say their systems lack connectivity with other providers and question whether the definition of an “interoperable” system even exists.

More than half of respondents in Europe, the Middle East, and South Asia plan to move away from siloed EHRs to more US-style offerings that include data exchange and care coordination.

Countries being held back by a lack of national infrastructure, policy, funding, or privacy rules include Japan, China, Qatar, Brazil, Taiwan, India, and Russia. The best-positioned ones include New Zealand, Denmark, Israel, Singapore, and Netherlands.

Lancaster, PA-based Connexion Health launches its walk-in, touchless, app-powered health assessment kiosk. According to its website, the kiosk “uses advanced AI to integrate a myriad of sensor data streams that independently would be incoherent. It syncs data derived from a laser, multiple cameras, IR, and microphones to provide incredibly precise analytics. More importantly, Connexion OS apps can enhance their capabilities with a unique, proprietary AI that allows them to guide people to better overall health outcomes.” The company was incubated by AI-focused Aspire Ventures. Target markets are sports teams, employee health, and healthcare providers.

Government and Politics

ONC’s budget would be cut from $60 million to $38 million, with its focus being interoperability and provider burden reduction.

HHS OCR would see its budget reduced from $39 million to $31 million.

Medicare and state Medicaid would be given some ability to negotiate drug prices

Post-acute care provider costs would managed with a payment system based on clinical needs rather than the site of care

Off-campus, hospital-owned physician practices would be paid at the same rate as other practices.

Prior authorization would be required for physicians who order services in excess relative to their peers.

The Independent Payment Advisory Board would be repealed.

The reporting burden and arbitrary requirements for use of EHRs would be eliminated.

MIPS reporting would be simplified.

Other

A 2,000-respondent healthcare leadership survey sponsored by Change Healthcare finds that 80 percent of payers are addressing social determinants of health for their members. Half of respondents think lack of digital health tool adoption is caused by security and privacy concerns.

China’s Ping An Technology describes the healthcare-related AI projects it is working on:

Interpret CT scans to reduce workload and improve accuracy

Use facial recognition for patient identification to reduce fraud and to allow patients to grant access to their medical records.

Use facial recognition for clock-in of healthcare workers to reduce fraud.

Create a vaccine record app for people in poor and remote areas that uses facial and voiceprint recognition.

Contacts

Top News

American Academy of Family Physicians asks HHS and ONC to reduce the health IT burden of clinicians, specifically recommending that they:

Eliminate the health IT usage metrics in MIPS since it already measures the end results of quality, cost, and practice improvement.

Eliminate the use of visit documentation E/M codes along with the box-checking tasks that are required for payment.

Focus on how and when data is exchanged rather than focusing on the individual data elements, with the goal being to reduce the irrelevant information that is automatically generated in exchanging CCDAs.

Penalize organizations that do not share information and align financial incentives so that “interoperability is good business.”

Fund the creation of consistent data models in a physician-led process.

Reduce the number of products and services that require prior authorization; develop a standard form that all payers use; require payers and PBMs that create a PA specifically to save themselves money to pay physicians for the time required to complete those forms; and eliminate PAs for durable medical equipment, imaging, supplies, and generic drugs.

Adopt a single set of quality measures that span all public and private payers.

Develop a single, EHR-populated form for justifying orders for medical supplies and services.

Reader Comments

From Pickleball: “Re: Bob Dolin. Professional organizations that I belong to have formal ethics codes and committees that would exclude individuals from membership for such behavior. I would suggest that HL7 needs to show some leadership in terms of standards, not just with respect to electronic formats. While societal interests aren’t served if a talented individual becomes unemployable after serving out a physician, Dolin’s crime as a physician was a particularly heinous violation of public trust. According to published accounts, he downloaded lots of images onto work computers, which might be relevant to informatics where one is interfacing to an organization’s computers or accessing EHRs that could include photos or private information about children. I tend to be empathetic and accepting of the frailties of individuals, but in this instance, I don’t think the informatics community should simply welcome Dolin back as though nothing happened.” For another viewpoint, I have run a lengthy comment as its own post titled “Readers Write: In Defense of Bob Dolin.”

From Constantine: “Re: a radiology question for your readers. Are any healthcare organizations sending preliminary results from a radiology AI application to the EHR prior to radiologist review?” It will be interesting to see if radiology departments trust AI analysis enough to post the preliminary interpretation in the EHR. My guess is no, but we will see.

From The PACS Designer: “Re: ICD-10 Head Injury from goose. The head injury in ICD-10-CM is: 2018 ICD-10-CM Diagnosis Code S07.9XXA Crushing injury of head, part unspecified, initial encounter.”

From Aleutian: “Re: Stanford cancer vaccine announcement. Sounds promising. What do you think will happen?” Oncologist Ronald Levy, MD and postdoctoral fellow Idit Sagiv Barfi, PhD (above) find that directly injecting a combination of immune-stimulating agents into mice tumors (breast, colon, and melanoma) kills both the tumor and any metastases, in essence curing cancer in 87 of 90 mice. If it works in humans – and that’s a big if – the treatment would offer a fast, cheap way to stop cancer in is tracks without the side effects inherent with tweaking the patient’s entire immune system. Stanford is starting clinical trials in lymphoma patients, for which we should all keep our fingers crossed. It sounds like they will find out quickly if it works since the effect is nearly immediate.

From Privacy Guy: “Re: DuckDuckGo’s privacy browser add-in. It doesn’t grade the HIStalk site well and they’re apparently anti-Google and Facebook.” The HIStalk low grade is because the site (a) doesn’t use encrypted sessions, and (b) articles sometimes link to rather innocent third-party systems such as Twitter and YouTube that can track user behavior. I’m considering implementing SSL security just because Google downgrades search results for unencrypted sites, but there’s little benefit otherwise – the only information you can enter here that could be intercepted would be an article comment.

HIStalk Announcements and Requests

Most poll respondents attend the HIMSS conference either because their job requires it or because they like socializing and visiting the exhibit hall. I can’t say I’m shocked.

New poll to your right or here: Would you be satisfied if your doctor prescribed a digital health app rather than a medication?

This week’s question is timely – if you’ve attended the HIMSS conference as an exhibitor, take a minute to share your thoughts about what you wished you had known beforehand.

Welcome to new HIStalk Platinum Sponsor Mobile Heartbeat. The Waltham, MA company is a leading provider of enterprise mobility clinical communications and collaboration solutions. Its Clinical Unified Results Enterprise (CURE) technology powers MH-CURE, which improves clinical workflow by giving clinicians what they want and need, no matter where they are. MH-CURE consolidates alarms, notifications, patient information, lab data, texting, voice, and photography. Some of the country’s largest health systems have reported results that include 31 percent faster clinician response time, 50 percent improvement in HCAHPS scores, and 50 percent reduction in noise. Its patient-centric Dynamic Care Team director connects team members – inside and outside the hospital – to the patients they are caring for, ensuring that patient alerts and notifications are sent to the right person, who can then quickly engage other team members. Thanks to Mobile Heartbeat for supporting HIStalk.

Webinars

February 13 (Tuesday) 1:00 ET. “Beyond Sliding Scale: Closing the Gap Between Current and Optimal Glycemic Management Practices.” Sponsor: Monarch Medical Technologies. Presenter: Laurel Fuqua, BSN, MSN, EVP/chief clinical officer, Monarch Medical Technologies. The glycemic management practices of many hospitals and physician staff differ from what is overwhelmingly recommended by experts and relevant specialty societies. As a result, they are missing an opportunity to improve the quality, safety, and cost of care for their patients with diabetes and hyperglycemia, which commonly represent more than 25 percent of their inpatient population. Hospitals that transition from sliding-scale insulin regimens to consistent use of basal / bolus / correction protocols are seeing reductions in hyperglycemia, hypoglycemia, and costs. Making this shift more effective and efficient is the use of computerized insulin-dosing algorithms that can support dedicated staff using a systematic approach.

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsor: Strata Decision Technology. Presenter: Patrick Nolan, VP of finance, Aurora Health Care. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

Q4 sales include $2.8 million deals with the DoD and Sutter Health as well as a system-wide implementation at BayCare (FL).

Lang says the company expects overall hospital IT spending to increase 5-7 percent in 2018, mostly for back-to-basics solutions that reduce cost or increase efficiency.

He says the BYOD movement is limited for hospital clinical workers and more health systems are instead providing company-owned devices for better security.

Widespread consumer acceptance of a voice user interface will open up possibilities and the company is investing in speech recognition technology.

CPSI announces Q4 results: revenue increased by 21 percent, EPS –$1.57 vs. $0.15, although the loss included a $28 million impairment charge. From the earnings call:

The company is working with Caravan Health to create the CPSI Rural ACO Program to help rural providers transition to value-based care.

The $28 million impairment charge is because of poor revenue and high development costs of the American HealthTech post-acute care product, which contributes 8.7 percent of CPSI’s revenue. (Healthland acquired American HealthTech in 2013 for an undisclosed price, then CPSI acquired Healthland for $250 million in late 2015).

15 percent of Evident clients are live on CommonWell.

The company hasn’t seen any impact from the Allscripts ownership of the former McKesson Paragon, which it says doesn’t really play strongly in CPSI’s target market of hospitals under 100 beds. The company’s strongest competition has shifted to Cerner, Epic Community Connect, Athenahealth, and Meditech.

An analyst asked why hospitals running older systems would replace them without government incentives, with the company answering that the driver is doctors who are unhappy with usability and software completeness, especially with those systems that were bought quickly to earn Meaningful Use money.

I missed this earlier: Quality System (NextGen) posts Q3 results: revenue up 3 percent, adjusted EPS $0.15 vs. $0.23, beating revenue expectations slightly and meeting on earnings. QSII shares have dropped 20 percent in the past year and are trading at their 52-week low, valuing the company at $800 million.

A review of the New York healthcare startup landscape predicts that health IT investment will decrease in an overheated market, with the hope that someone will buy digital health companies that are losing too much money to run an IPO. Most of the M&A involved big companies buying point solutions vendors for under $100 million. A growth equity executive says hospitals are busy running expensive EHR implementations and insurer consolidation has left fewer customers in that sector, so pharma is the best bet.

Announcements and Implementations

DrFirst announces a mobile e-prescribing app intended to improve opioid prescribing by integrating with state PDMP databases, providing medication history and medication adherence information, and making it easier to prescribe shorter-term therapy that can be easily extended if needed.

Other

Healthcare spending jumped 15 percent from 2012 to 2016, not because patients consumed more services, but because providers keep raising their prices unsustainably even as usage declines. Surgical admissions declined 16 percent, but the average price increased $10,000 to $42,000.

In China, a man playing games on his phone while sitting on the toilet for 30 minutes has a rectal prolapse and requires emergency treatment. You publish-or-perish academics might want to create an observational study to determine how many people (with a male vs. female comparison) whip out their phones during stall visits of greater than two minutes.

Contacts

Top News

Former GE Chairman and CEO Jeff Immelt is named board chair of Athenahealth, replacing co-founder and CEO Jonathan Bush. Under a plan announced last year to appease an activist investor, Bush will remain CEO but will relinquish his president and board chair titles. The president’s job has not been filled.

Immelt will invest in Athenahealth and will buy $1 million of its shares on the open market.

A company SEC filing says Immelt will get standard Athenahealth board member compensation: a $60,000 annual cash retainer (plus another $50,000 per year for serving as chair), $281,000 in shares, and travel expense reimbursement.

Immelt ran GE from 2001 through 2017, during which time the company’s share price dropped 56 percent vs. the Dow’s 120 percent gain.

Reader Comments

From Bad Robot: “Re: Epic’s MyChart Central. Its terms and conditions clearly state, ‘You hereby expressly assume the sole risk of any unauthorized disclosure or intentional intrusion.’ Are they really off the hook in the event of a data breach?” I found the same wording in the T&C of a bunch of MyChart-using health systems, with additional interpretation suggesting that it’s to warn patients that their PCs or Internet connections could be compromised and thus might expose their information. Attorneys who would like to weight in can review Cleveland Clinic’s MyChart T&C, which basically says they are responsible for nothing even though that is most likely far from the truth. I assume Epic supplies the legal boilerplate, although it’s probably correct that Epic isn’t liable for any breach of a system it doesn’t host.

From Whistle Blower: “Re: Bob Dolin. The former Kaiser doctor and HL7 board chair served prison time starting in 2015 for possession of child pornography involving sadistic abuse of infants and toddlers. He’s apparently out now and attended an HL7 working group meeting last week. He’s also working with former Kaiser colleagues at Elimu Informatics as a senior clinical informaticist. Given recent news of US Gymnastics, can you imagine if the former chairman went to prison and then returned to participate?” I emailed HL7’s media contact but did not get a response indicating what role, if any, Dolin has with the organization. His LinkedIn says he’s an independent consultant. Here’s where I’m a little bit torn – what he did was incredibly sick, but should he barred from making a living after he has served his sentence and the job doesn’t involve contact with children? I have to say I’m leaning toward no – his informatics work isn’t likely to be a springboard to more crime. It’s still OK to detest him for what he did, but banishing him to a lifetime of unemployment in his late 50s doesn’t seem to improve public safety.

From Bombshell: “Re: ‘Giving Up Baldrige.’ It’s supposedly an HIT tell-all book that covers IT gaffes, Meaningful Use fraud, and Baylor’s Dr. Death and the suspiciously extensive wiping of computers.” I haven’t heard of it and neither has Google.

Webinars

February 13 (Tuesday) 1:00 ET. “Beyond Sliding Scale: Closing the Gap Between Current and Optimal Glycemic Management Practices.” Sponsor: Monarch Medical Technologies. Presenter: Laurel Fuqua, BSN, MSN, EVP/chief clinical officer, Monarch Medical Technologies. The glycemic management practices of many hospitals and physician staff differ from what is overwhelmingly recommended by experts and relevant specialty societies. As a result, they are missing an opportunity to improve the quality, safety, and cost of care for their patients with diabetes and hyperglycemia, which commonly represent more than 25 percent of their inpatient population. Hospitals that transition from sliding-scale insulin regimens to consistent use of basal / bolus / correction protocols are seeing reductions in hyperglycemia, hypoglycemia, and costs. Making this shift more effective and efficient is the use of computerized insulin-dosing algorithms that can support dedicated staff using a systematic approach.

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsor: Strata Decision Technology. Presenter: Patrick Nolan, VP of finance, Aurora Health Care. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

Acquisitions, Funding, Business, and Stock

Q4 bookings were $2.3 billion, up 62 percent quarter over quarter and $300 million above guidance.

Full-year bookings were up 16 percent.

Cerner’s Works businesses are selling well, but their lower margin and short-term higher expenses are affecting earnings.

The company will invest most of the windfall it will receive from the federal tax rate cut from 35 percent to 21 percent, planning to expand its campuses and hire 600 employees for the Works businesses.

The company raised EPS guidance by $0.05, but that’s after a $0.19 gain from the tax rate change.

The VA’s failure to sign a contract as expected in Q4 hurt results, although the company wasn’t expecting a huge revenue and earnings bump anyway.

Cerner signed six Q4 deals of over $75 million.

The company says the hospital EHR market has matured, with the biggest opportunity being full implementations in small hospitals that don’t have a currently marketed EHR.

Privacy and Security

Aetna sues Kurtzman Carson Consultants — the claims administrator that sent out mailings on Aetna’s behalf that disclosed the HIV status of recipients because of poor envelope design – for the $20 million Aetna paid out as a result.

Decatur County General Hospital (TN) notifies patients of a September data breach in which an unknown hacker installed cryptocurrency mining software on its vendor-maintained EHR server. The hospital didn’t name the vendor, but its patient portal is CPSI’s.

Announcements and Implementations

Carolinas HealthCare System – one day after renaming itself to Atrium Health – announces that it will merge with Navicent Health (GA). Atrium is also in merger talks with UNC Health Care (NC).

Technology

Innovation and Research

A study of 14,000 Apple Watch users finds that the device’s heart rate sensor is capable of detecting diabetes in users already diagnosed with the disease with 85 percent accuracy.

Other

A federal judge throws out a False Claims Act lawsuit brought against Epic by a former compliance employee of WakeMed (NC), who claimed in 2015 that Epic’s default setup double-bills Medicaid and Medicare by charging for both anesthesia base units and procedure time. The judge called the case, which had already been declined by the Department of Justice, “woefully deficient” since it included no proof that fraud had actually occurred. Epic’s motion to dismiss said the single document offered as proof by the plaintiff was not an anesthesia bill or claim.

A 20-minute power outage at Royal Adelaide Hospital in Australia leaves two patients undergoing surgeries in the dark, three patients stuck in elevators, and a score of anxious others. Officials have since pointed fingers at the hospital’s management company, which has attributed the unplanned outage at the recently opened $1.9 billion hospital to software glitches and a backup generator that ran out of gas.

Contacts

Top News

Former CMS Acting Administrator Andy Slavitt joins several luminaries to launch the non-profit United States of Care, a non-partisan group that will push for federal healthcare policies that it believes are nearly universally supported despite political differences.

Among its members are health system executives, actors, Mark Cuban, Atul Gawande, former US CTO Todd Park, and former Republican Senate Majority Leader Bill Frist.

Reader Comments

From Orbiter: “Re: HISsies awards. I got my ballot, but how are you presenting the results without an HIStalkapalooza?” I could do some kind of Web extravaganza via GoToWebinar with celebrity participants and live reaction from the winners (perhaps including a virtual pie in the face), with the cost underwritten by the “worst vendor” winner. Or, maybe I’ll just run the PowerPoint results sometime before, during, or after the HIMSS conference. Guess which?

From Integumentary Film: “Re: HIMSS. What are you looking forward to most?” Two things: (a) not having to deal with HIStalkapalooza headaches, and (b) checking out vendors undercover in the exhibit hall. I have planned nothing for the entire week – no events, no meetings, no must-see educational sessions – so I’ll just be letting the HIMSS breeze (including the inevitable hot air) carry me.

HIStalk Announcements and Requests

Does it seem that there’s less industry news to read today? It’s that time of year when vendors start creating their backlog of self-serving announcements, mistakenly thinking that they’ll get more exposure and booth traffic if they hold off announcements until Tuesday, March 6. HIMSS is just 25 days away and the smart companies are building the PR momentum now instead of after it’s too late to take advantage of it.

Webinars

February 13 (Tuesday) 1:00 ET. “Beyond Sliding Scale: Closing the Gap Between Current and Optimal Glycemic Management Practices.” Sponsor: Monarch Medical Technologies. Presenter: Laurel Fuqua, BSN, MSN, EVP/chief clinical officer, Monarch Medical Technologies. The glycemic management practices of many hospitals and physician staff differ from what is overwhelmingly recommended by experts and relevant specialty societies. As a result, they are missing an opportunity to improve the quality, safety, and cost of care for their patients with diabetes and hyperglycemia, which commonly represent more than 25 percent of their inpatient population. Hospitals that transition from sliding-scale insulin regimens to consistent use of basal / bolus / correction protocols are seeing reductions in hyperglycemia, hypoglycemia, and costs. Making this shift more effective and efficient is the use of computerized insulin-dosing algorithms that can support dedicated staff using a systematic approach.

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsor: Strata Decision Technology. Presenter: Patrick Nolan, VP of finance, Aurora Health Care. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

Acquisitions, Funding, Business, and Stock

Cerner announces Q4 results: revenue up 4 percent, adjusted EPS $0.58 vs. $0.61, missing Wall Street expectations for both. President Zane Burke describes the company’s FY2017 as, “We finished the year on a mostly positive note, with record bookings and all other key metrics except for earnings in line with our expectations,” which glosses over the significant point that the company’s all-important profit number disappointed everyone, including Cerner itself.

JPMorgan billionaire CEO Jamie Dimon had to soothe the ruffled feathers of the company’s healthcare clients after the announcement that his company — along with Amazon and Berkshire Hathaway – will work together to reduce the healthcare costs of their 1.2 million employees. The company’s healthcare bankers – who drive $682 million in annual revenue – reassured their customers that the partnership won’t really be as disruptive as people are wildly speculating, but instead will be more like a group purchasing organization that will help the companies negotiate better prices for services their employees consume. Insiders say that more-disruptive activities that were discussed, especially with Amazon’s involvement — such as offering health insurance, starting a pharmacy benefits management company, and distributing drugs – are now off the table.

NantHealth CEO Patrick Soon-Shiong is rumored to be close to acquiring the Los Angeles Times and San Diego Union-Tribune for $500 million. Declining business and a series of missteps at the LA Times by owner Tronc – the former Tribune Publishing, in which Soon-Shiong is a major shareholder – have resulted in a two-thirds cut in reporting staff, heavy-handed management intervention into editorial issues to appease advertisers, and a vote by newsroom employees to join the union.

Sales

Announcements and Implementations

Michigan Medicine offers virtual visits for minor illnesses such as adult flu, offering a same-day response to symptom questionnaires submitted by noon or within 24 hours if completed later in the day. The seven-day-per-week service costs $25 and is accessed through the health system’s Epic MyChart patient portal.

LifeImage launches Clinical Connector, a vendor-neutral, standards-based platform by which clinicians and patients can access medical images and information from PACS and EHRs across sites. The project began as the LifeImage-powered RSNA Image Share pilot that winds down in March.

DrFirst announces that its real-time prescription benefit checking service has been used 6 million times, saving patients an average of $11 for a 30-day prescription.

Government and Politics

This isn’t directly health IT related, but it’s important for healthcare journalism, of which I’m the fringest of players. CMS threatens to ban Modern Healthcare Washington bureau chief Virgil Dickson from its news conferences after he wrote a story blaming the resignation of a high-ranking Medicaid official on that official’s clashes with CMS Administrator Seema Verma. I Googled the name of the spokesperson who told Dickson’s editor that he would be banned unless he rewrote his story — Brett O’Donnell is working under a private contract with CMS after (or during) his career as a political communications consultant (nicknamed “Tea Party Whisperer”), during which he pleaded guilty in 2015 to lying to House ethics investigators.

Privacy and Security

In England, Department of Health officials admit that every one of 200 NHS trusts have failed new, tougher cybersecurity requirements, many of them because of delays in system patching.

Other

Google’s DeepMind reports “promising signs” from its research project with NHS Moorfields Eye Hospital to analyze retinal scans with AI to detect eye disease. Its report has been submitted to a peer-reviewed medical journal.

In Ireland, a review of last year’s incident in which the country’s national imaging system was found to ignore the “less than” symbol finds that no patients were harmed as a result. The Health and Safety Executive says Change Healthcare did not tell it about a software update that fixed the problem, so it didn’t apply that update.

Lancaster County, PA’s Coalition to End Homelessness creates a social services data system that allows people to sign up for multiple programs with a single, universal electronic form that sends information to 40 participating organizations and then allows the groups to coordinate their efforts. The local health system CEO says she has HIPAA concerns with such a project and the hospital won’t participate because it doesn’t have the resources. The cloud-based system vendor is CaseWorthy, which says its system meets HIPAA requirements. It is apparently working on integrating its system with Epic.

In Australia, a coroner finds that an inpatient’s death after routine knee surgery was due to a drug overdose that was caused by an anesthesiologist entering the wrong product in Macquarie University Hospital’s just-implemented InterSystems TrakCare system. The doctor admitted that he wasn’t trained on the system and didn’t follow up when he noticed his patient wearing a pain patch that he didn’t intentionally prescribe.

Vince takes a look back 30 years, when magazine ads featured decisive hospital executives wearing three-piece suits and clinicians literally dancing with EHR delight, which might make you think the hospital IT wars had been fought and won to the musical backdrop provided by chart-toppers Tiffany and the manufactured Latin-influenced band Exposé.

This tweet is brilliant.

Sponsor Updates

DocuTap employees restock The Teddy Bear Den, an incentive and education program for limited-income pregnant women and their children.

Contacts

Top News

The Economist reviews the number of prescription-only digital health apps that have earned FDA approval or could so more quickly under FDA’s new pre-certification program.

Apps are being approved to actually treat conditions – either alone or in combination with a drug – but investors are watching to see how companies fare since the “who pays” question hasn’t been answered and nobody’s sure how a patients will react to being given an app instead of a pill.

Pear Therapeutics won FDA approval in September 2017 for its ReSet app for substance abuse treatment. Its pipeline includes apps for schizophrenia and post-traumatic stress disorder. The Boston-based company, founded by neuroscientist Corey McCann, MD, PhD, raised $50 million in a Series B funding round last month that increased its total to $70 million.

Reader Comments

From Eloquent Rascal: “Re: Apple Health Records. Does it display any information that patients can’t already see in their EHR portal? Can patients change the information?” A source tells me that, so far anyway, the patient’s phone will show consumers nothing that they can’t already see on the patient portal. Patients can apparently change or hide information, which makes their phone-stored information of limited use to clinicians who may not trust it.

HIStalk Announcements and Requests

My poll tool doesn’t calculate percentages like you might expect when allowing multiple choices, but it’s safe to say that most respondents use their phones for health-related activities. Relatively few, however, use the information contained on it during their provider visit, view their progress notes via OpenNotes (although that obviously requires their hospital to participate), or seek out a video visit.

New poll to your right or here: if you’re going to the HIMSS conference, why?

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

Webinars

February 13 (Tuesday) 1:00 ET. “Beyond Sliding Scale: Closing the Gap Between Current and Optimal Glycemic Management Practices.” Sponsor: Monarch Medical Technologies. Presenter: Laurel Fuqua, BSN, MSN, EVP/chief clinical officer, Monarch Medical Technologies. The glycemic management practices of many hospitals and physician staff differ from what is overwhelmingly recommended by experts and relevant specialty societies. As a result, they are missing an opportunity to improve the quality, safety, and cost of care for their patients with diabetes and hyperglycemia, which commonly represent more than 25 percent of their inpatient population. Hospitals that transition from sliding-scale insulin regimens to consistent use of basal / bolus / correction protocols are seeing reductions in hyperglycemia, hypoglycemia, and costs. Making this shift more effective and efficient is the use of computerized insulin-dosing algorithms that can support dedicated staff using a systematic approach.

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsor: Strata Decision Technology. Presenter: Patrick Nolan, VP of finance, Aurora Health Care. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

Acquisitions, Funding, Business, and Stock

From the Athenahealth earnings call following positive quarterly results that sent shares up 14 percent Friday:

CEO Jonathan Bush says the company is seeing a post-HITECH “sugar low” as overall buying demand slacks off. Bookings for the fiscal year didn’t meet the company’s goal.

The company will change its software release schedule to three times per year following disappointing customer retention numbers.

62 hospitals are fully live on its inpatient system.

40 percent of customers are exchanging patient records via CommonWell and Carequality. Bush says the they can see hospital CCD information on an application tab, but the next steps involve extracting the most useful information and then developing APIs to allow users to interact directly with a hospital’s EHR.

The company’s main strategy will be to deepen the number of services offered to mitigate the “micro aggressions against the practice of medicine” and to emphasize its network’s capabilities rather than assuming that offering the best EHR or PM will create demand.

Bush says the previously “clunky” single, integrated view of inpatient and outpatient patient records view is improving as the company hopes to avoid being “boxed out” in being replaced by a single integrated system such as Epic or Cerner.

Epocrates continues to turn in poor numbers, although it’s no longer being positioned as a standalone product but instead as a dashboard for other Athenahealth offerings.

The company spent a lot of money and annoyed doctors as it fought to get a significant share of HITECH-driven business, but now it is transitioning to more thoughtful product offerings.

Bush says MACRA and MIPS won’t drive sales since practices “get the check something like two years after you make the move and the check is smaller than cable bill.”

Bush says high-deductible insurance has pushed patients to defer services until later in the year when they’ve met their deductible, with providers and their vendors facing lean first quarters as the new normal.

People

Government and Politics

A GAO report finds that federal and state governments are spending $10 billion for assisted living services for Medicaid beneficiaries without much oversight or quality monitoring. It concludes that CMS has provided unclear guidance, Congress has not established standards, and states haven’t tracked cases involving neglect or abuse.

Other

Hospitals are being overwhelmed with record-breaking numbers of flu-related ED visits and admissions, to the point that Lehigh Valley Hospital-Cedar Crest (PA) erected a MASH-style “surge tent” in its ED parking lot to hold overflows. Patients housed there who didn’t get a flu shot told the New York Times reporter some bizarre theories that “heard” (meaning that they cluelessly read on Facebook):

When offered a Tamiflu prescription, “No, I heard it causes hallucinations. I heard about a lady whose daughter got Tamiflu and tried to kill her.”

“I hear the [flu] shot gives you flu.”

“I heard you can get Alzheimer’s from it — that there’s mercury in it, and it goes to your brain.”

“I heard it’s a government plot for population control.”

“As a family, we don’t get it,” an apt description from a man convinced that he got the flu more often in years when he got a flu shot.

Canada’s Royal Canadian Mounted Police reverses its decision to require officers to file an Access to Information Act to get copies of their own medical records after being overwhelmed by requests and complaints about delays. The 30,000-employee RCMP has 65 people working in its access-to-information and privacy office, which scanned 1.2 million pages of documents last year. Documents requested under the Access to Information Act have to be printed from their electronic original and shipped to the access and privacy office in Ottawa, where they are then scanned back in.

An NHS surgeon who claimed in a job interview to have performed over 50 solo keyhole surgeries vs. his real-life total of six says he didn’t understand the question and instead gave a “guesstimate.” He got the job after submitted a fraudulently completed surgery logbook, but was investigated after a high incidence of post-surgical complications and death. He’s been found guilty of fraud.

Sponsor Updates

T-System will provide its T-Sheets flu templates to EDs and urgent care centers at no charge.

Contacts

Top News

Advocate Health Care will replace Cerner and Allscripts with Epic as part of its merger with Epic-using Aurora Health Care, as speculated here ever since the merger – which will create the country’s 10th-largest health system — was announced in December 2017.

Advocate SVP/CIO Bobbie Byrne, MD, MBA said in a statement, “This transition will allow for better interoperability throughout our entire geographic region, benefiting patients through a seamless, integrated approach. We are confident this single-platform EHR will be a nimble, long-term solution that can be continually adapted and developed as technology advances to keep us on the leading edge.”

Webinars

February 13 (Tuesday) 1:00 ET. “Beyond Sliding Scale: Closing the Gap Between Current and Optimal Glycemic Management Practices.” Sponsor: Monarch Medical Technologies. Presenter: Laurel Fuqua, BSN, MSN, EVP/chief clinical officer, Monarch Medical Technologies. The glycemic management practices of many hospitals and physician staff differ from what is overwhelmingly recommended by experts and relevant specialty societies. As a result, they are missing an opportunity to improve the quality, safety, and cost of care for their patients with diabetes and hyperglycemia, which commonly represent more than 25 percent of their inpatient population. Hospitals that transition from sliding-scale insulin regimens to consistent use of basal / bolus / correction protocols are seeing reductions in hyperglycemia, hypoglycemia, and costs. Making this shift more effective and efficient is the use of computerized insulin-dosing algorithms that can support dedicated staff using a systematic approach.

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsor: Strata Decision Technology. Presenter: Patrick Nolan, VP of finance, Aurora Health Care. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

North Carolina will become the 45th state to implement Appriss Health’s PMP InterConnect platform to share prescription drug monitoring program data across state lines.

In UAE, VPS Healthcare will implement the Tasy EMR from Philips. I’ve never heard of it, but Googling suggests that Philips acquired the Latin American-focused EHR in 2010 and started rolling it out in Europe last year.

Announcements and Implementations

In Saudi Arabia, Johns Hopkins Aramco Healthcare goes live on Epic.

Government and Politics

Former CDC Director Brenda Fitzgerald, MD denies that she resigned because of newly uncovered tobacco stock sales and instead attributes her resignation to a tangled web of financial conflicts — including investments in Greenway Health – that she couldn’t get out of easily.

Technology

Yale New Haven Hospital (CT) works with Epic to design a Capacity Command Center that uses dashboards to display real-time insight into patient volume, staffing, and environmental services.

Privacy and Security

Fresenius Medical Care North America will pay $3.5 million to settle HIPAA violations related to five separate breach incidents that happened in early 2012. HHS OCR found problems that include failure to conduct a risk assessment, improperly disclosing PHI, failing to develop policies to address security incidents, and improper movement of PHI-containing hardware and media.

Other

Analysis verifies that 5 percent people who are commercially insured account for 53 percent of healthcare spending, but it’s not the same people year after year – 61 percent of them moved off the top spender list from 2014 to 2015. The takeaway: consumers who buy crappy health insurance (or none at all) because they think they’re healthy might get a big financial surprise, especially as ACA changes allow policies to be sold without pre-existing condition coverage or with newly reinstated lifetime caps.

CHIME decides to pick up the federal government’s slack and create an opioid task force that will attempt to come up with solutions to the opioid epidemic using the expertise of its members and their access to data. Some might wonder if this is a PR push similar to its National Patient ID Challenge, which CHIME decided to shut down last year for lack of viable entries.

Pediatrician Bryan Vartabedian, MD says even Silicon Valley couldn’t create an EHR that doctors wouldn’t hate because “it’s less about design and more of what’s required of doctors.”

Nordic will exhibit at the HIMSS Wisconsin Dairyland Event February 8 in Madison, WI.

PatientSafe Solutions exhibits at the San Diego Health IT Summit February 1-2 in San Diego.

The American Heart Association/American Stroke Association and Nordic help University of Colorado Health and Saint Francis Hospital – both Epic sites – optimize quality measure reporting for stroke patients using the ASA’s Get with Guidelines-Stroke program.

Spok publishes a case study describing how Woman’s Hospital (LA) overcame logistical and communications challenges caused by record flooding to manage a 27 percent increase in call volume and to track physicians down using secure messaging.

Contacts

Top News

Epic issues a rare press release to tout “One Virtual System Worldwide,” new functionality that includes components called Come Together (gathering data), Happy Together (presenting data from multiple sites in MyChart), and Working Together (allowing users to take action across Epic-using organizations).

Epic sites using Working Together can:

View thumbnail images from other Epic sites, which when clicked will retrieve a reference-quality image.

Book appointments with another Epic site to which a patient is being referred.

Reader Comments

From Portal Data Download Blues: “Re: patient portals. Apple’s Health Records has drawn attention to patient portal data, but providers and EHR vendors aren’t great at keeping those running despite collecting Meaningful Use dollars. The download function of University of Washington’s MyChart hasn’t been working for weeks. Either it’s not popular or there are too many obstacles to getting the data. Probably both.”

From WorryWart: “Re: hackers demanding bitcoin. Looks like that practice has started without health records. It’s scary to think about emails starting with, ‘We know you have a mental health condition – deposit two bitcoin or we release it.’ Could be the end of bitcoin itself.” The FBI warns of a surge in emails that start with, “I’ve got an order to kill you” but then offer to cancel the hit for $2,800 in bitcoin.

From Potential Voter: “Re: the HISsies awards. How can folks vote?” I directly sent ballots to the 13,000 or so people who have signed up for HIStalk email updates. Those ballots are tied to their email addresses, limiting votes to one per reader in preventing ballot box stuffing (SurveyMonkey is brilliant and — as far as I know, unique — in offering that option inexpensively). Those emails went out Monday night and around 700 ballots have been completed as I write this. So far, the majority’s vote matches my own in 14 of 16 categories.

HIStalk Announcements and Requests

What do you wish you’d known before bringing an ambulatory EHR live? Take a few seconds to tell me to increase your enjoyment of reading the collective recap later this week.

I’m anxious to load up on Cerner shares and maybe some Adobe given the obvious analytical prowess and overall attention to accuracy by this PhD-claiming editor, who offers on the side his services described as, “Enhance you’re allowing to compose me to edit and alter your archive for the standard linguistic and expressive blunders that we all make.” I shall hazard a guess – supported by a lack of LinkedIn contact information for Dr. Editor – that his American-sounding name wasn’t any more parentally assigned than that of an unintelligible, far-away call center rep claiming to be “Chuck” or “Wayne.”

USA Today’s technology columnist bangs out a quick story, “I tried Apple’s improved Health app. Here’s what I found,” that buries a critical point about his Health Records test drive 15 paragraphs down: “Since none of the 12 health institutions are in my back yard or store my data, I could only go so far in testing the updated app.” Translation: all he did was navigate to the Health Records login screen.

Webinars

February 13 (Tuesday) 1:00 ET. “Beyond Sliding Scale: Closing the Gap Between Current and Optimal Glycemic Management Practices.” Sponsor: Monarch Medical Technologies. Presenter: Laurel Fuqua, BSN, MSN, EVP/chief clinical officer, Monarch Medical Technologies. The glycemic management practices of many hospitals and physician staff differ from what is overwhelmingly recommended by experts and relevant specialty societies. As a result, they are missing an opportunity to improve the quality, safety, and cost of care for their patients with diabetes and hyperglycemia, which commonly represent more than 25 percent of their inpatient population. Hospitals that transition from sliding-scale insulin regimens to consistent use of basal / bolus / correction protocols are seeing reductions in hyperglycemia, hypoglycemia, and costs. Making this shift more effective and efficient is the use of computerized insulin-dosing algorithms that can support dedicated staff using a systematic approach.

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsor: Strata Decision Technology. Presenter: Patrick Nolan, VP of finance, Aurora Health Care. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

Acquisitions, Funding, Business, and Stock

Amazon, Berkshire Hathaway, and JPMorgan will create an independent company to provide healthcare services to their 1.2 million employees that will be “free from profit-making incentives and constraints.” Warren Buffett referred to healthcare in the announcement as “a hungry tapeworm on the American economy,” Amazon’s Jeff Bezos said that “reducing healthcare’s burden on the economy while improving outcomes for employees and their families would be worth the effort,” and JPMorgan Chase CEO Jamie Dimon said the company will create solutions that not only benefit employees, but “potentially, all Americans.” That’s nearly $200 billion of net worth talking. Skeptics note that big businesses have tried and failed in the past to band together to force provider costs down, but healthcare-related stocks still led the market sharply down Tuesday after the announcement.

Dell may undertake a reverse merge with publicly traded VMware – of which it already owns 80 percent, gained in its $67 billion merger with EMC in 2015 – to allow Dell to become publicly traded without running a separate IPO. It would be the biggest merger in tech history, allowing Dell’s shareholders to reap the benefits of the merger and helping Dell pay down its $50 billion in debt. VMware’s growth has slowed as customers move from running data centers with virtual servers to cloud-based systems.

Washington University School of Medicine (MO) signs a partnership agreement with Israel-based MDClone to aggregate research data from BJC HealthCare in the company’s the first deal outside of Israel. The 25-employee MDClone was founded in March 2016 by Ziv Ofek, who started dbMotion and sold it to Allscripts for $235 million in 2013.

Government and Politics

A GAO report to Congress says the US Coast Guard is placing service members at risk because it went back to paper recordkeeping following its attempt at implementing Epic, which consumed seven years and $60 million (not counting internal and external labor costs) before the project was abandoned in October 2015. USCG retired two legacy systems that Epic was supposed to replace, with project’s failure forcing it back to paper and Microsoft Office applications. USCG had implemented the DoD’s old CHCS system in 2002, but decided the cost of moving to AHLTA in 2009 wasn’t worth it and instead signed a $14 million contract for Epic’s ambulatory EHR. It found during implementation (!!) that several other of its legacy systems were outdated, requiring a project expansion to include another 25 vendors at an additional cost of $56 million. GAO analysts found poor project oversight and still-undocumented lessons learned. The GAO recommends that USCG get moving on deciding what it wants to do given that it launched a procurement process in February 2016 and identified its desired solution in October 2017. USCG responded that it plans to award an EHR contract later this fiscal year. USCG’s health division covers 50,000 service members, retirees, and dependents from its 41 clinics and 125 sick bays (easily depressed taxpayers shouldn’t perform the cost-per-member math of yet another bungled government software project). In a follow-up House committee hearing, Rep. Duncan Hunter (R-CA) pressed USCG to “not waste time and money” and simply choose Cerner as did the DoD and VA, but Rear Admiral Michael Haycock says that while that’s an option USCG is considering, more due diligence is needed before signing a contract.

Iowa’s state senate is reviewing a bill filed by the Board of Pharmacy that would make it illegal for providers to hand-write prescriptions, which worries the state’s medical society, which fears that providers won’t be ready by the the July 1, 2019 compliance date.

Privacy and Security

Innovation and Research

HD Medical markets a Bluetooth-connect stethoscope that captures heart sounds as well as EKG waveforms, with FDA approval pending.

Other

A doctor in Canada is suspended for one month for altering the electronic medical record of a patient after she died, modifying several notes to falsely indicate that the patient had refused treatment recommendations.

Jen Gunter, MD writes a hilarious, occasionally profane, and brilliantly scathing recap of her undercover attendance at the “In Goop Health” conference run by Gwyneth Paltrow-owned Goop and the out-there medical claims made by its speakers.

I was initially worried they wouldn’t let me register, but some quick homework told me they had offloaded registration to a third party, so I thought it highly unlikely there was a no-fly list. I did consider that I was just full of myself and they just didn’t care about me attending; however, along the way I received a tip that the Goopsters hate me more than gluten, cow’s milk, and McChemicals combined, so I think they just never thought I would go … There were non-toxic manicures that smelled as bad as regular manicures, some weird facial station that involved a mask that looked like an early prototype from “Phantom of the Opera,” and Sonic Womb music … There was a drink that tasted like the inside of a spa. If you actually rinsed down a spa and put the effluent into bottles, this is what it would taste like. There was also charcoal lemonade. It tasted like lemonade. The guy handing it out said it was good for “toxins.” I explained that charcoal was an antidote for poisoning and that it did not bind toxins and that I was toxin-free. He didn’t care. At “In Goop Health, ” the truth is irrelevant and words are meaningless … The actual content started at 10 a.m. GP (her formal name, no one calls her Gwyneth) was the mistress of ceremonies, and for such a seasoned actress, she said “um” a lot. She looked fine, but up close she looks her age, so there is no magic in Goop skin care products. The glowing twenty-something skin on the magazine covers is just the power of Photoshop.

In India, a hospital visitor dies after accompanying an elderly family member to the MRI room while carrying the patient’s oxygen tank, causing the 32-year-old to be sucked into the MRI machine where he was crushed. I’m guessing that someone offers a magnetic or metal-detecting door sensor that won’t allow anyone to enter an MRI room with metal when the machine is turned on.

Contacts

Top News

Outcome Health’s co-founders – CEO Rishi Shah and President Shradha Agarwal – step down from their management roles as part of a settlement with investors who had claimed that the company misled them about its performance.

Shah and Agarwal will remain on the company’s board as chair and vice-chair, respectively. They will also join Outcome Health’s equity investors and lenders in investing $159 million to improve its technology and customer operations.

Outcome Health will expand its board to include new independent directors and will launch a search for a new CEO. It will also hire an outside firm to audit the performance of its waiting room ad campaigns, which was the subject of an investigative report suggesting that the company had inflated the numbers. Several big-name investors then alleged that the company had defrauded them of $500 million.

Reader Comments

From Digital Dork: “Re: Apple Health Records. I don’t see why everyone is so excited. Patients can get the same information from their provider’s patient portal. It doesn’t even include OpenNotes.” I’m surprised that the perpetually underperforming health IT industry expected more from Apple’s beta release. The important takeaways are:

It’s Apple — which has high consumer trust and high adoption rates — connecting via FHIR to EHRs. That’s significant news in itself.

Patients don’t like and use patient portals all that much. Replacing little-used portals with an IPhone-stored aggregated record is a pretty big deal to consumers.

Apple can extract and display whatever information the FHIR standard supports. The beta isn’t the end of Health Records development and it’s early to be whining about what it doesn’t do instead of celebrating the fact that Apple was interested enough in patient EHR data to use it as an IPhone differentiator in an increasingly Android world.

If enough IPhone users want OpenNotes, diagnostic images, or anything else that’s stored in the EHR, they may eventually get it.

It’s a big deal to give app developers a way to build and sell their products without the permission or participation of EHR vendors.

Health systems may be overwhelmed with patients wanting their data or demanding that errors they find in it be corrected.

From Apple The InfoBlockers: “Re: Apple Health Records. Your source said they were more comfortable working with Apple, but patients have a right to their data. Why does it bring over a subset of data but not pathology reports, radiology reports, notes, and genomic data? ONC railroaded the public with Meaningful Use that didn’t give patients the full data from their EHR, but this gets the word out about patient-centric interoperability. It also puts to bed excuses by provider / vendor info-blocking consortia like DirectTrust, who have argued that patients can’t participate without in-person identity verification and the Halamka argument that ‘we don’t make patient data available because nobody wants it.’ FHIR is one of the most powerful info-blocking tools out there and Argonaut in particular is a forum where providers define use cases that work behind the backs of patients. But that game is up since supporting a FHIR interface via a patient portal token means you can support it with any application the patient wants.” It may be that a tiny percentage of patients want to see their entire medical record, and even though there’s always the paternalistic fear that they might apply that information unwisely, I agree it’s their right. However, the average IPhone user is probably more interested in appointments, messaging, and quick access to lab results than second-guessing their pathology notes. Also recall that this is a beta release, a minimum viable product whose development will surely continue if demand exists. The reader observes that only three of the participating health systems use OpenNotes and Health Records doesn’t extract it anyway, so the patient portals of those three Epic sites will offer more information. I’m all for enhancing electronic records access, but what makes me really angry are the extortionate prices health systems charge patients to get even paper copies of their own records, especially when in-house technology makes producing them nearly effortless.

From Madison Ashley: “Re: Apple Health Records. The story in a Madison newspaper says Microsoft has shut down HealthVault just like Google did its Health app in 2011.” It doesn’t say that, only that some of its software has been turned off (it’s referring to the just-retired HealthVault Insights). However, an error-filled article posted on a questionable health IT news site boldly declared that Microsoft has “shut down HealthVault,” only one of many mistakes it cluelessly stated as fact — HealthVault insights has not been “around since 2007,” HealthVault was never renamed to HealthVaults Insights, and Microsoft hasn’t ended its “mHealth app experiment” (although it might as well). Be careful who you trust for health IT news.

From Bob: “Re: HIMSS exhibitor staff rules. I’ve search endlessly trying to find your rules from a few years ago, such as no talking on cell phones or to each other.” I’ve riffed a few ideas out several times over the years, so since I get asked several times each year right about this time, I started a permanent list. See my “Tips for HIMSS Exhibitors” and send me your additional ideas.

HIStalk Announcements and Requests

It’s a nearly even split on whether Epic is an impediment to innovation. Dev says the risk-averse health systems that spend hundreds of millions of dollars on Epic demand stability and that difficulty of integration is also a factor, adding that organizations can’t continue to wait two years for Epic to implement something and then take another year to run it by their in-house steering committees. Vic says both Epic and Cerner discourage third-party participation in installation, enhancements, and maintenance. Hermanator says its leadership, not the brand of EHR, allows provider organizations to innovate. Ex-Epic says the company’s aversity to PR and marketing mean customers, employees, and the health IT industry are kept in the dark, adding that Epic’s no-acquisition policy runs contrary to Silicon Valley, where everyone wins when side projects or acquisitions can change the world in the right hands.

New poll to your right or here, as a follow-up to the Apple Health Records announcement: which of these activities have you performed on your phone?

I’ve talked to a few former KLAS employees about how their process works. I would be interested in talking to a couple of additional people just so I get the full picture, all anonymously of course. Contact me.

Listening: Massachusetts-based Speedy Ortiz, which overcomes an obviously limited inventory of talent to create some pretty good grungy rock. They donated their last tour’s proceeds to Girls Rock Camp Foundation. The singer studied math and music for two years before taking a poetry degree from Barnard College. The music is edgy enough to be interesting even when it’s not all that great. There’s also the new album from pastor and songwriter Cory Asbury, who crafts polished and highly listenable worship music.

Welcome to new HIStalk Platinum Sponsor DocuTAP, which I’m sure will interest Dr. Jayne given her not-great EHR experience in her urgent care practice. The Sioux Falls, SD-based company is the industry-leading technology provider for urgent care centers, offering a tablet-based PM/EHR, patient engagement, revenue cycle management, and business intelligence solutions. EHR features include a chart room to track patient wait times and complaints, templates that can be modified per provider and per clinic, automatically generated procedure codes, single-tap order sets, and automated E/M coding. DocuTAP also streamlines occupational medicine and workers’ compensation workflow that includes converting all forms to be filled out electronically and supporting employer-specific fee schedules. It offers connectivity with ACOs, state HIEs, and local hospitals. DocuTAP acquired Clockwise.MD in April 2017, allowing it to offer patient self-scheduling, wait time viewing, text reminders, and automated post-visit surveys. The company provides 24/7 support and offers certified remote hosting. Users benefit from two-minute charting, a $10 per visit revenue increase, and 15-minute shorter wait times. Thanks to DocuTAP for supporting HIStalk.

For those questioning DocuTAP’s two-minute documentation claim, here’s a video showing it in action.

Webinars

February 13 (Tuesday) 1:00 ET. “Beyond Sliding Scale: Closing the Gap Between Current and Optimal Glycemic Management Practices.” Sponsor: Monarch Medical Technologies. Presenter: Laurel Fuqua, BSN, MSN, EVP/chief clinical officer, Monarch Medical Technologies. The glycemic management practices of many hospitals and physician staff differ from what is overwhelmingly recommended by experts and relevant specialty societies. As a result, they are missing an opportunity to improve the quality, safety, and cost of care for their patients with diabetes and hyperglycemia, which commonly represent more than 25 percent of their inpatient population. Hospitals that transition from sliding-scale insulin regimens to consistent use of basal / bolus / correction protocols are seeing reductions in hyperglycemia, hypoglycemia, and costs. Making this shift more effective and efficient is the use of computerized insulin-dosing algorithms that can support dedicated staff using a systematic approach.

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsor: Strata Decision Technology. Presenter: Patrick Nolan, VP of finance, Aurora Health Care. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

Four-hospital Alameda Health System (CA) chooses Epic in a $200 million project. The health system nearly went broke following billing struggles after its $77 million implementation of Siemens (now Cerner) Soarian and NextGen in 2011.

Decisions

North Shore Medical Center (FL) switched from a Medhost EDIS to Cerner in late 2017.

Stephens County Hospital (GA) will go live with Wellsoft’s EDIS in February 2018.

Astria Sunnyside Hospital (WA) will switch from Meditech to Cerner in mid-2018.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.

People

Scott Decker (MDLIVE) joins Homecare Homebase as president.

Announcements and Implementations

Allscripts says it has restored all systems after its January 18 SamSam ransomware attack. Meanwhile, Surfside Non-Surgical Orthopedics (FL) files a class action complaint against Allscripts, saying the outage caused it to lose revenue and spend money coordinating with patient. The practice says the industry has known about SamSam ransomware since March 2016 and Allscripts failed to take reasonable security measures to protect its systems. None of this has affected Allscripts shares, which are up 7.1 percent since the attack vs. the Nasdaq’s 6.13 percent.

A new Reaction Data report asked 133 radiologists and radiology administrators about the potential use of AI in diagnostic imaging. Most respondents say it’s going to a big deal, although practicing radiologists are skeptical. The report notes that folks who say they aren’t all that familiar with AI also responded that it’s important, a case of what Reaction data calls FOMO (fear of missing out). Most respondents say they will implement some form of AI by 2020, while imaging centers surprisingly seem to have fallen far behind hospitals in progress so far. IBM leads in AI mindshare even though nobody reported implementing anything from IBM – most of the progress is in breast imaging and Hologic, GE Healthcare, Google, and ICAD lead the pack.

Privacy and Security

Hackers steal more than $500 million in cryptocurrency from a Tokyo-based digital currency exchange startup.

Other

In England, a newspaper’s report says doctors are being pressured to manipulate patient EHR data to avoid hospital penalties for missing ED treatment time targets. Sources say they are changing admission times, performing phony patient transfers that sometimes makes it hard to find those patients, and discharging and then readmitting patients to restart the clock. NHS standards require patients to be assessed within four hours of entering the ED and to be held no longer than 12 hours before being admitted, although the stopwatch starts only when they are taken to an exam room rather than when they show up, excluding their wait time watching My Lady Her Honour Judy.

Google AI researchers publish (in a non-peer reviewed, non-medical open access journal) their work on extracting full EHR data from 215,000 hospitalized patients (from UCSF and University of Chicago Medicine) to successfully predict in-hospital deaths, unplanned readmissions, prolonged stays, and discharge diagnoses. The authors conclude that analyzing the full EHR with deep learning methods provides predictions that are more accurate than other predictive models that require data harmonizing and a pre-defined statistical model.

A proposed Singapore bill addresses the country’s National EHR (NEHR):

Providers will contribute the electronic information of all patients to the NEHR.

Contacts

Every year I get several emails asking me to repost the “HIMSS vendor rules” that I’ve rattled off a few times over several years. The problem is that I’ve never made an exhaustive list or committed to maintaining it – it was just a series of stream of consciousness complaints about sloppy exhibitor practices that frustrated me as an attendee. I often called out undisciplined booth staffers who turned an expensive HIMSS exhibit into “the world’s most expensive telephone booth.”

I decided to try to recapture some of those thoughts in one place after I received recent requests for “the list” now that HIMSS is fast approaching. Here’s what I came up with. Send me your additions, especially if you – unlike me – have worked a booth and have a non-attendee viewpoint that I lack.

My conclusion is this. HIMSS exhibition costs are among a company’s most significant investments (especially for small companies) and the cost/revenue meters are running every minute that the exhibit hall is open. Don’t spend a fortune on exhibiting without a plan.

Pre-HIMSS Preparation

Define success goals. What is your company trying to get out of exhibiting? Is it X number of leads or contacts per hour? Doing X number of demos? Just staying hello to existing customers? Getting rid of all the optimistically ordered crappy swag and going to parties? Everyone working the booth should know what the company hopes to gain from their exhibit hall presence and how their contribution to those outcomes will be measured.

Develop two conversations that every booth staffer must demonstrate: a 10-second elevator pitch covering the problem the company solves and a two-minute version for those who seem interested after hearing the shorter spiel. The wording is as important as any marketing message since it will be repeated hundreds of times in the high-stakes exhibitor game, so get it right and make sure everyone can deliver it well. Trade show messaging is different than any other form of contact with customers and prospects, so don’t let staffers – even the salespeople – wing it.

Define how to qualify a visitor as a prospect and the actions that will ensue – disengagement if they aren’t, deeper engagement if they are. It’s OK to break off a conversation with sincere thanks for stopping by and a goodbye handshake. For chattier non-prospects who don’t take the hint, define a “rescue me” hand signal triggers the appearance of a profusely apologizing co-worker who reminds you that you have a fictitious previously scheduled visitor waiting.

Create a plan for getting even hot prospects in and out of the booth within 10 minutes of saying hello. Don’t waste their time and yours by trying to wear them down into signing a contract right there on the show floor. It’s fine if they want to stick around afterward, but the plan should address what needs to happen within that 10-minute window to make it a success. Then move on to other prospects.

The 10-minute model visit should include who else needs to be brought in or how handoff to another booth staffer with specific knowledge or skills will take place. Nobody likes being walked all over the booth while you’re hunting for someone who turns out to be in an impromptu company meeting.

Perform role-playing to make sure everyone is on the same page for all likely situations (snooping competitors, reporters looking for a story, loudly complaining customers, newly sold customers looking for validation, or attendees asking about job opportunities). Don’t use the “X number of dollars per hour” booth time stage for rehearsal.

Define dress expectations. Company shirts? Suits? Specific colors? Don’t leave it up to the discretion of staffers. Casual is fine unless the company sells abstract services rather than a physical product, in which case more formal dress might be appropriate in conveying success and strength.

Define clearly what your company does on your booth. Second- and third-tier vendors sometimes don’t realize that most of us don’t know who they are or what they do. Say so clearly on booth materials so encourage attendees to veer off their determined path to check your booth out.

Set up a quiet cocktail party or dinner – at the appropriate cost level for your intended audience and potential benefit – and offer promising prospects who drop by the booth an invitation. Don’t just hand them out en masse or try to arrange something at the last minute. The only negative is that attendees come with fully-loaded schedules, so maybe a nearby lunch would be a good substitute. HIMSS Bistro works great, is inexpensive, offers healthy options, and is located just off the show floor.

If you plan to offer giveaways, consider fun items for the attendee to bring home to their children.

Booth Layout

Use high-top tables and stools that encourage qualified prospects to move into one-on-one conversations, but not so comfortable that visitors and booth staff sprawl on them because their feet are tired.

Instead of swag giveaways that encourage trick-or-treat behavior from people who aren’t really prospects anyway, offer coffee, juice, soda, and water. Place it in a comfortable seating area free of barriers, but assign someone to work that area and strike up conversations, giving the evil eye to people from other companies trying to freeload.

Bring enough people to handle, but not overwhelm, visitors. That’s based on booth size and in-booth activities. A 10×10 booth will seem overloaded if there’s more than a couple of people working since the visitor might not have a place to stand or sit, while an oversized but understaffed exhibit feels dead or leaves visitors unacknowledged. Have backups readily available that can be summoned when needed but free to do other work nearby while waiting.

Choosing Booth Staff

Don’t assign booth duty as reward or punishment. Define the individual roles and choose for them the best people who actually want to work the show. Enthusiasm wins.

Rotate booth staff frequently to keep energy levels up.

Strive for diversity and make sure the male and female staffers don’t huddle around each other like a middle school dance.

Assign some non-management technologists or non-sales subject matter experts to be available for bonding with their prospect peers and for answering questions without resorting to salesperson bluffing. However, don’t let them interact with visitors without having a more people-facing handler managing the process.

Don’t choose smokers. The inevitable scent will turn off many attendees and those folks will require frequent smoke breaks that someone else will have to cover.

It is perfectly fine for a small company to hire contract booth staff, even if they are chosen primarily because of appearance (rightly or wrongly, attractive booth staff often deliver better results). However, those contractors should be educated in advance about the company, its solutions, and how to make a quick handoff to an expert after the initial contact. Obviously they should dress appropriately and be prepared to interact professionally with high-level visitors. Provocatively-clad “booth babes” are never, ever a good idea for the HIMSS conference.

Assign a single person to be in charge of the entire booth and the people working in it at all times. Like the on-duty restaurant manager, their job is to keep staffers motivated, make sure they follow the plan, provide help when needed, and intervene in a “good cop” kind of way when needed. That person is the boss of everyone during exhibit hall hours, even of other employees who outrank them.

The CEO should be present in the booth for at least part of the time, and not just chatting with cronies on an isolated couch. Assign them a handler who will facilitate an introduction to good prospects but who will protect them from being bothered otherwise. Unlike other booth staff, the CEO should be in full-out executive suit/dress mode to convey their position of authority and to make a good impression on prospects and passersby. The CEO may well be the company’s best relationship builder and closer, so use them wisely. Admit it – when you walk by the booths of Epic or Athenahealth, you are slyly looking around to see if Judy Faulkner or Jonathan Bush are there.

Preparing the Booth Staff

Put out a specific schedule with who will be where, including breaks off the show floor for bathroom visits, lunch, checking voice mail, etc.

Map out who will stand where and what responsibilities they have.

Put friendly, gregarious people on the booth’s perimeter. They don’t have to be experts – they are like a barker whose job it is to get people comfortable enough to cross into the carpeted space. They should be quick to make eye contact, greet the person by name, and move them into the next phase (watching a demo, getting literature, etc.) The aisles around the booth are the most important real estate in the exhibit hall and getting prospects to leave them to enter the booth is the most important objective.

Give everyone a list of known customer attendees (culled from the HIMSS registration list) so they can be greeted warmly and personally instead of being pitched unknowingly as a stranger.

Before the Hall Opens

Relieve booth staffers of all other responsibilities. Leave them free and energized to complete the expensive project you started when you bought a booth.

Confiscate the phones of everyone who is working the booth.

Do a booth staffer huddle 10 minutes before the hall opens to make sure that everyone is dressed neatly (no bagel debris lodged between their teeth), their phones have been surrendered, everybody knows about the day’s special activities or presentations, and their energy level has been elevated just before the doors open. It’s really embarrassing to have your people sitting around drinking wake-up coffee and comparing notes about last night’s wild party as prospects are walking by.

When the Show Floor Is Open

Make it an inviolable rule – enforced by the booth manager — that people working in the booth cannot sit, talk to each other (unless trying to get a visitor’s question answered), use their phones, or eat. Do those things away from the booth. Prospects will move on if they feel they’re invading the space of those on duty. No exceptions, and if you didn’t free up their time so they can focus on visitors, shame on you.

Keep the trash cans emptied and handbags and luggage out of sight. That seems minor, but it makes an impression.

Always have a greeter working the aisle. They need to hand off quickly and get back to their greeting job.

Remember that even when booth staffers are away from the booth, they’re still wearing a nametag identifying their employer, so business-appropriate behavior is mandatory. Save the swearing, romantic recruitment, calls to headhunters, and product and co-worker gripes for a different setting. Or, at least tell them to flip their badges over so nobody who is overhearing knows who they are.

Resist the urge to let folks bail out early because there’s no foot traffic. Some C-level decision-makers intentionally use slow exhibit hall hours to seek information without the frenzy.

Use the time before the exhibit hall opens and closes, as well as the slow last day of the exhibits, to cruise the hall looking for opportunities to partner, acquire, or hire. Many companies find that they get more value from their interactions with other vendors than with prospects, often outside of their own booth.

As the show winds down, find similar but non-competing vendors and offer to share leads.

Managing the Visitor Encounter

The greeter should turn the visitor over quickly and smoothly to someone else so they can keep working the perimeter.

Ask the visitor if it’s OK to scan their badge. Not only to capture their information, but to keep them in the booth a few seconds longer while both parties decide how interested they are.

Engage in a friendly manner with demo shoulder-surfers. They probably aren’t trying to steal trade secrets but rather are just avoiding wasting their time and yours with premature engagement. It’s certainly OK to say hello and ask if they need any help.

Don’t disparage competitors. It will sound like sour grapes.

Define the documentation that should result from a visitor visit – badge scan, business card, or information sheet? Capture the conversation so that any follow-up is seamless – what are their organization’s problems or who should follow up?

Don’t assume that a visitor’s job title disqualifies them as a decision-maker. Provider organizations often make decisions that start with a lower-level department employee who is sent out to fact-find.

Don’t assume that consulting company attendees aren’t worth talking to. They are probably looking for products they can recommend to their clients or looking for partnership opportunities.

North Carolina health systems Novant and Wake Forest Baptist Health allow patients to combine their Epic MyChart information into a single view.

Open source EHR vendor OpenMRS receives a $1 million donation from a philanthropy organization started by one of its patch contributors.

Best Reader Comments

Can the patient manually add info to their file? Can they choose which info they want to share? Could they hide diagnoses, medications, etc.? I would think providers would be skeptical about the completeness and accuracy of patient-provided info. (Kermit)

How will Apple market this app to Epic MyChart users? Positives: Can likely have info from multiple providers in one location instead of pulling up MyChart accounts from each provider. Negatives: I didn’t see any patient access or billing topics and no provider messaging. So, user would still need to access MyChart to view upcoming visits, manage appts,. make payments, complete forms/questionnaires, update demographics, start an E-Visit. (Lynn Geren)

This is no surprise to many of us. I have been commenting here for years that PF was inflating (lying about?) its number of users. This is just a continuation of that pattern. (Numbers skeptic)

Epic actually created this initiative with Apple. 10 of the 13 sites involved are Epic sites and each of them will tell you Epic supported them in this endeavor. Epic has had Lucy and VDT and full access for Open Notes sites for a very very long time. (Nope)

I’m not sure I get what Novant and Wake have done. Happy Together is baked into Epic with the most recent version. The patient controls the joining of the MyChart instances across provider instances. Sounds more like marketing to me. (Defiant)

There are lots of after-market solutions for downtime EMRs and “lite” charts like the one Dr. Jayne described, and these often will pay for themselves after just once downtime. It’s a smart investment. (Cosmos)

A T&A implementation is perhaps the most complex project an organization undertakes for many of the reasons stated in the post. The main reason is that management is unaware or does not acknowledge the varying pay practices across their organizations. They underestimate the implications of these practices and are unprepared to deal with them during a T&A project. It is not unusual to find that these practices are costing organizations millions of dollars a year, year after year. I ask clients, are you prepared to pay everyone to policy? (Alan Bateman)

You can’t get comfortable and coast [in your current job]. If you do, you’ll wake up one morning and find yourself out the door when least expected. (HIS Junkie)

Both on purpose and unintentionally, as organizations seek out better solutions and question massive spend, bids can tilt towards the current vendor or away from it. As information is gathered across the organization, departments seek out wants and nice-to-haves framed against the current system. Often this leaves the current vendor in an unfair position, but just as often, the new vendor simply and smartly addressed weaknesses of competitors.(Don’t think twice it’s alright)

Watercooler Talk Tidbits

HIStalk readers funded the DonorsChoose teacher grant request of Ms. T from the South Bronx of New York asked for 50 STEM take-home self-exploration kits covering everything from solar mechanics to tin can robots for her middle schoolers. She reports, “Since the kits are self-contained, they can read and follow directions and carry out the various experiments on their own. They will then demonstrate their experiments for the class on Monday. This will give them an opportunity to show what they have learned. They will be the expert as they field questions from their peers. Some students are shy about making presentations. This will give them another opportunity to develop and practice their public speaking skills.”

A NEJM opinion piece on physician burnout describes a University of Colorado team-based family medicine ambulatory care model redesign called APEX that has dropped clinician burnout rates from 53 percent to 13 percent, improved vaccination and referral rates, and reduced patient wait times. Provider productivity improvements made it cost-neutral. The patient’s visit starts with a medical assistant who gathers data, reconciles meds, lays out the visit, and identifies preventive care opportunities before the physician or PA enters the exam room. The MA stays in the room to document the visit, and after the clinician leaves, works on patient education and health coaching. The medical director says pre-APEX exam rooms were like “texting while driving,” but now the computer doesn’t intrude between clinician and patient, allowing the clinician to focus on synthesizing data, performing the physical exam, and making medical decisions without distraction.

A Los Angeles TV station’s investigation finds that up to 25 percent of reviews on Google, Facebook, and Yelp – including those for healthcare professionals such as dentists – are fake. A Beverly Hills dentist says he’s puzzled at several glowing reviews featuring reviewers whose profile photos feature images of minor TV celebrities, stock photos, or those of random people. I suspect that the dentist is in fact quite familiar with phony review services offered cheaply on Fiverr and other sites – why would anyone post glowing fake reviews otherwise?

The non-profit, invitation-only Healthcare Innovators Professional Society (HIPS) for chief innovation officers and chief strategy officers launches from Texas Medical Center. Memorial Hermann CIO and Chief Strategy Officer David Bradshaw said that as a founding member, he’s looking forward to networking “without the chaos and scale of other major healthcare societies and conferences.” Membership is limited to 33 people and is not only free, it also covers the full cost of attending HIPS-related events, the first of which will be October 2-4 in Houston. I admire that the provided lunches feature Houston-specialty food by Goode Co BBQ and Lupe Tortilla.

A newspaper reviews the bizarre patient cases that have been reported in BMJ Case Reports. They include:

A man who nearly blinded himself by mistaking Super Glue for eye drops

A woman with Crohn’s disease symptoms that were being caused by pieces of a Heinz plastic container lodged in her intestines

A woman’s suspected eye lesion that turned out to be Christmas card glitter

A heavy smoker’s suspected lung cancer that was actually part of a toy set that had been lodged in his lung since he was seven years old

Top News

CNBC sheds light on the millions of dollars that Practice Fusion’s executives will reap when the company’s fire sale to Allscripts at 1/15 of its one-time, self-assessed value is completed.

Practice Fusion stakeholders say they were misled by an executive team that was touting a a bright future even as growth was stalling, founder and CEO Ryan Howard was fired, headcount was slashed, and the company had pitched itself to 40 potential buyers starting in November 2015, receiving bids at just $50-225 million for the company that had valued itself at $1.5 billion in early 2016. A group of employees is trying to assemble enough voting shares to remove the payouts to the executives.

Allscripts was the original bidder at $225 million, but backed out when EClinicalWorks was hit by a $155 million settlement related to falsifying EHR certification testing results. Allscripts came back with its offer of $100 million in cash, which Practice Fusion accepted on January 8.

Webinars

February 13 (Tuesday) 1:00 ET. “Beyond Sliding Scale: Closing the Gap Between Current and Optimal Glycemic Management Practices.” Sponsor: Monarch Medical Technologies. Presenter: Laurel Fuqua, BSN, MSN, EVP/chief clinical officer, Monarch Medical Technologies. The glycemic management practices of many hospitals and physician staff differ from what is overwhelmingly recommended by experts and relevant specialty societies. As a result, they are missing an opportunity to improve the quality, safety, and cost of care for their patients with diabetes and hyperglycemia, which commonly represent more than 25 percent of their inpatient population. Hospitals that transition from sliding-scale insulin regimens to consistent use of basal / bolus / correction protocols are seeing reductions in hyperglycemia, hypoglycemia, and costs. Making this shift more effective and efficient is the use of computerized insulin-dosing algorithms that can support dedicated staff using a systematic approach.

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsor: Strata Decision Technology. Presenter: Patrick Nolan, VP of finance, Aurora Health Care. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

Acquisitions, Funding, Business, and Stock

Change Healthcare retains the exclusive right to license commercial data to WebMD Health Corp. It seems there was some legal disagreement over which company had the rights to sell de-identified data to third parties after the parent company of both businesses sold them off.

Allscripts is apparently still struggling to bring Professional EHR and PM back to normal following last week’s ransomware attack, with reports that some customers can’t access the system through the desktop application. The company also warns that the restored system might be slow and suggests that customers use the mobile solution when possible. Analytics Platform and Clinical Data Warehouse are still down.

Sales

Mee Memorial Hospital (CA) chooses Cerner Millennium under the CommunityWorks cloud deployment model. The hospital has the best tagline in history: “At Mee, it’s all about you!”

Announcements and Implementations

Intermountain Healthcare will transfer 2,300 billing employees to its revenue cycle vendor R1 RCM, expecting to save $70 million in the next three years even though the employees will keep their pay rate, health insurance, and tenure at Intermountain. The health system’s COO, questioned by employees worried that the company will outsource its IT operations that include its Cerner system, says Intermountain has not yet made any IT decisions but needs to manage its costs.

Technology

Apple announces new beta functionality within its Health app that will let patients at a dozen partner hospitals view their medical records on their IPhones. Participating EHR vendors include Epic, Cerner, and Athenahealth. More detail and insider reports here.

Government and Politics

The VA will use data, analytics, technology, and best practices from CMS to combat fraud and abuse within its programs.

One Brooklyn Health (NY) will use a $700 million investment from the state’s Vital Brooklyn plan for technology and facility improvements to its three hospitals, plus the creation of a 32-facility ambulatory network. Technology upgrades in the $70 million range will include development and installation of a system-wide EHR.

Privacy and Security

The CEO of Hancock Health (IN) provides details of its recent ransomware attack:

The hospital believes the hackers were members of an Eastern Europe criminal group.

They obtained (by unstated means) the login credentials of one of the IT department’s hardware vendors.

The hackers then attacked a server at the hospital’s backup site.

To stop the ransomware’s spread, the IT department had to immediately shut down all network and PC hardware, not easy since the attack was launched in the evening when many PC-using employees had left for the day.

The hospital decided to pay the $55,000 ransom when it found no good way to remove the encrypted files and replace them with backup copies because the connection between the backup and live sites was compromised by the ransomware. They later found that the backup files had also been corrupted by the ransomware, which would have required paying the ransom in any case.

Employees struggled to figure out how to buy Bitcoin, but once they paid the ransom, the hackers restored the system quickly.

Other

36 percent of poll respondents (C-level company execs and investors) say health IT is in a bubble vs. 29 percent in 2015.

The health IT market needs to grow 7-13 percent annually to support the current rate of investment.

The market pushes companies to balance the long-term value creation caused by serving customers while catering to investors who expect them to innovate using buzzword-worthy technologies such as AI and blockchain.

The most actively sought acquisitions are in population health and analytics, RCM technology and services, payer services, and infrastructure technology. Hospitals as a target market led the way by far.

The most important acquisition characteristics are growth trajectory and recurring revenue, while strong management finished last.

Most executives say the regulatory impact of the Trump administration won’t affect their company’s performance or acquisition strategy.

2017 saw zero health IT IPOs following nine, eight, and five, respectively, from 2014 to 2016.

Cabell Huntington Hospital (WV) donates $35,000 to Tri-State STEM+M School, with its VP/CIO Dennis Lee (right) making a classroom visit along with the hospital’s CEO.

Contacts

Apple announced Wednesday an update to the IPhone’s IOS 11.3 beta that will allow consumers to view their EHR information from one or more participating providers within Apple’s existing Health app. I spoke to insiders at some of the beta sites to get more information.

Patients will be able to view information extracted from the provider’s EHR that includes their allergies, conditions, immunizations, lab results, medications, vital signs, and procedures. The encrypted information is stored on the user’s IPhone rather than on Apple’s servers. Apple will not be able to see the information unless the user gives their permission.

“It’s interesting,” one provider told me, “that Apple is possibly the most proprietary, closed software and hardware vendor and Epic is sometimes seen as its healthcare equivalent, yet they are connecting using open standards. That’s awesome.”

Patients of Epic-using health systems, for example, log into their MyChart account, retrieve an authorization code, and agree to share it with Apple. They then receive a token. “The process is slick,” a provider told me, adding that the process will likely be further polished and hardened to allow hospitals to onboard more easily. Epic will most likely productize the access method via an App Orchard app.

Apple’s Motivation

It’s important to note that Apple, unlike consumer medical records competitors such as Google, sells only hardware. Apple doesn’t develop enterprise apps, sell or use patient data, or have ambitions to build or acquire an EHR company. “Their only goal is to sell more IPhones,” a health system source said, adding, “we’re a lot more comfortable working with them than other companies with less-transparent ambitions.” Having direct access to EHR information is a differentiator from Android-based competitors whose market share is increasing over the IPhone.

The IPhone presents more than just a static display. Allergies include severity levels and lab results include the provider’s normal range and an explanation of the results.

I asked an insider about the testing involved and was told that Apple “does real testing, not just the usual hospital user acceptance testing.” That person was also impressed with the depth of health IT expertise that Apple has hired.

Apple’s Gliimpse Acquisition

Apple in mid-2016 acquired startup Gliimpse, which was developing a platform by which consumers could collect and share their health information. That company described itself as, “Gliimpse solved the hardest medical data problem, aggregation plus standardization. Our product collects data from medical portals – without human intervention – combined with self-entered plus wearable info, all shared with others. Through Oauth & APIs, partners can build consumer and analytic apps.” Some of that technology or subject matter expertise presumably found its way into Health Records. Apple is also working on a variety of health sensors.

Apple is losing smartphone market share worldwide, though it leads the industry in profits. It is not likely that an Android phone maker can muster the resources and ecosystem control to develop something similar, although Google may try if it can enlist hospital development partners. Google retired its Google Health app due to lack of adoption after just four years in 2012, before the widespread use of EHRs, interoperability standards, and personal health devices. It ended up being a little-used place for people to manually enter their own health information that was then stuck inside the app.

What the Mainstream Press is Missing

The mainstream press is dutifully re-wording Apple’s announcement, but is missing some significant but unstated points that will impact the health IT industry.

Patients can store information from multiple health systems on their phones, turning themselves into mini-HIEs as they can simply show any other provider their aggregated information. Apple fixes the patient identification issue that plagues HIEs by requiring the patient themselves to establish the connection from the EHR patient portal’s log-on.

Apple or a third-party developer could, at some point, add the ability for patients to push their data to a different, non-connected provider in the absence of other available integration in an app-powered form of “sneakernet.”

Apple’s use of the FHIR standard gives it the capability to extract any information supported by the FHIR standard and the specific EHR vendor.

Apple’s high-profile rollout will not only sell more IPhones, but will also encourage patients to press their providers to offer EHR connectivity to Health Records. It will also increase consumer use of patient portals.

Consumers trust Apple and will be encouraged to think of their medical data as their own since it will be in the palms of their hands.

App developers can build products that use previously inaccessible patient information, having Apple as a single, reliable data source instead of being hamstrung by a hospital’s EHR vendor and the technical intricacies of FHIR, vocabulary, and data validation.

App developers can list their products on Apple’s App Store – as Epic and Cerner do — instead of only in the EHR vendor’s marketplace since they are directly installable by any consumer without prior arrangement, giving those apps a wide audience and easy monetization.

Possible apps made possible by Health Records include medication information or cross-checking; further interpretation of lab results; patient education tools based on actual patient data;combining activity data that is already being collected within the existing Apple Health app with newly available provider data; and sifting through real-time information updates to provide alerting of relevant changes.

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